TK, 


A 


A    TEXT-BOOK 


OF 


Alkaloidal  Therapeutics 


BEING  A  CONDENSED  RESUME  OF 
ALL  AVAILABLE  LITERATURE  ON  THE 
SUBJECT  OF  THE  ACTIVE  PRINCI- 
PLES ADDED  TO  THE  PERSONAL 
EXPERIENCE  OF  THE  AUTHORS 


BY 

W.  F.  WAUGH,  M.D.,  AND  W.  C.  ABBOTT,  M.D. 

WITH   THK  COLLABORATION   OF 

E.    M.    EPSTEIN,    M.D. 


CHICAGO 

THE   CLINIC    PUBLISHING  CO 

1904 


II 


-1         !•)       'J 

LU    7T, 


w-"B  ^  b  0 
t 


COPYRIGHT 


THE    CLINIC    PUBLISHING  COMPANY 
1904 


This     Book 


IS    DEDICATED    TO    THOSE 
WHO    BELIEVE  IN 


'THE  SMALLEST  POSSIBLE 
QUANTITY  OF  THE  BEST 
OBTAINABLE  MEANS  TO 
PRODUCE  A  DESIRED 
THERAPEUTIC  RESULT." 


<   III 

a. 


-J 


PREFACE 


The  authors  of  this  book  have  long  recognized  the  urgent  neces- 
sity for  a  work  upon  Alkaloidal  Therapeutics  that  should  be  as  com- 
plete as  the  present  knowledge  of  the  subject  will  permit,  hence  this 
book.  The  physicians  who  practice  Alkalometry,  who  have  rejected 
the  crudity  and  inexactness  of  the  galenicals  for  the  elegance,  ac- 
curacy of  dosage  and  activity  of  the  active-principle  remedies,  are 
now  counted  by  the  tens  of  thousands,  and  their  number  is  constantly 
increasing.  And  yet  the  "standard"  text-books  generally  ignore  this 
therapeutic  movement  and  devote  no  more  space  to  this  important 
subject  than  did  similar  books  two  or  three  decades  ago — in  some 
cases  even  less. 

The  Alkaloidal  idea  is  "in  the  saddle ;"  its  phenomenal  growth, 
in  the  face  of  active  opposition  and  without  the  "weight  of  author- 
ity" to  give  it  standing,  is  the  strongest  evidence  of  its  vitality.  Its 
enthusiastic  advocates  are  creating  for  it  a  rich  literature,  but  one 
which  is  scattered  through  many  journals  and  books — American 
and  European.  Works  of  reference  must  be  created  to  collect,  sup- 
plement and  "codify"  this  widening  stream  of  material,  in  order  to 
make  it  immediately  available  to  the  Alkaloidal  student  and  prac- 
titioner. This  is  the  mission  of  our  book :  to  get  together  from  all 
sources  all  the  facts  obtainable  concerning  the  alkaloids  and  active 
principles,  and  to  present  them  in  a  ready-to-use — truly  "alkaloidal" 
— form.  That  many  omissions  have  been  made  we  are  well  aware — 
there  are  limitations  to  the  perfection  of  all  human  work — but  the 
work  may  be  taken  as  it  stands  as  a  fair  digest  of  the  topics  treated 
upon. 

The  student  or  physician  who  becomes  interested  in  Alkaloidal 
therapeutics  is  sure  to  want  in  his  library  all  the  available  literature 
upon  the  subject.  We  suggest  that  the  following  books  be  procured  : 
Shaller's  excellent  "Guide  to  Alkaloidal  Medication,"  Waugh's 
"Treatment  of  the  Sick ;"  Abbott's  "Alkaloidal  Digest"  and  the  three 
volumes  of  American  Alkalometry  now  published  (others  to  fol- 
low). In  addition  there  is  now  in  course  of  preparation  an  extended 
work  upon  Alkaloidal  Practice  which  will  be  a  companion  volume 
to  the  Alkaloidal  Therapeutics.  The  practician  who  is  provided  with 


ii  PREFACE 

all  these  books — and  studies  them — will  get  renewed  enthusiasm  in 
his  profession  and  more  pleasure  and  profit  in  its  practice. 

In  the  preparation  of  this  book  we  wish  especially  to  acknowl- 
edge our  obligations  to  Dr.  E.  M.  Epstein  for  his  painstaking  re- 
search of  the  European  literature  of  alkaloidal  therapeutics.  Nearly 
every  page  bears  some  impress  of  his  able  delving.  We  are  also  un- 
der a  great  debt  to  the  thousands  of  members  of  the  Clinic  "family," 
who  have  aided  us  by  their  clinical  experience  and  inspired  us  by 
their  constant  encouragement. 

In  treating  of  articles  whose  therapeutic  uses  have  been  de- 
veloped largely  or  exclusively  by  the  eclectics  the  authors  have 
drawn  liberally  upon  King's  Dispensatory  by  Felter  and  Lloyd,  and 
on  Ellingwood.  Many  other  writers  have  also  been  consulted,  as 
will  be  seen. 

Blank  pages  have  been  introduced  throughout  the  book ;  we  hope 
that  our  friends  will  use  these  to  record  their  experiences  with  these 
remedies  and  that  they  will  report  their  successes  and  failures,  either 
directly  to  the  authors  or  through  the  columns  of  The  Alkaloidal 
Clinic. 

THE  AUTHORS. 

Chicago,  May  I,  1904. 


CONTENTS 


PAGE 

ACONITINE I 

jESGULIN    IO 

AGARICIN   n 

ALETRIN , 13 

ALNUIN 13 

ALOIN   14 

ANEMONIN 17 

APIOL  ig 

APOCYNIN 22 

APOMORPHINE    , .  24 

ARBUTIN    28 

ARECOLINE    32 

ARSENIC  . . . ., 34 

ASCLEPIDIN 50 

ASPARAGIN    52 

ASPIDOSPERMINE 53 

ATROPINE 57 

AVENINE     72 

BAPTISIN    73 

BARIUM  CHLORIDE  76 

BAROSMIN  78 

BEBEERINE    78 

BENZOIC  ACID  79 

BERBERINE    85 

BOLDINE   88 

BRUCINE 91 

BRYONIN   94 

BUTYL  CHLORAL  HYDRATE 96 

CACTIN  98 

CAFFEINE 99 

CALCIUM   CARBONATE  108 

CALCIUM  IODIZED  112 

CAMPHOR  MONOBROMIDE   117, 

CANNABIS  INDICA   120 

CANTHARIDIN 123 

CAPSICIN    129 

CAULOPHYLLIN    134 

CEPHAELINE    137 

CERIUM   OXALATE   137 

CETRARIN    138 

CHELIDONIN 139 

CHIMAPHILIN    142 

CHIONANTHIN    143 

CICUTINE   143 

ClNCHONIDINE     ISO 

ClNCHONINE     151 

COCAINE  151 

CODEINE   160 

COLCHICINE    163 

COLLINSONIN    168 

COLOCYNTHIN 171 

CONDURANGIN    172 


CONTENTS. 

PAGE 

CONVALLAMARIN    176 

COPPER  ARSENITE    J78 

CORNIN    179 

CORNUTINE    1 80 

CORYDALIN    183 

COTOIN     184 

CREASOTE  185 

CROTON  OIL   : 186 

CUBEBIN    187 

CURARINE     l88 

CYPRIPEDIN    190 

DIASTASE  191 

DIGITALIN    iQ3 

DlOSCOREIN     208 

DUBOISINE  SULPHATE  2OQ 

ECHINACEA   2IO 

ELATERIUM  212 

EMETINE  213 

ERGOTIN   219 

ERYTHROL  TETRANITRATE 223 

EUONYMIN  223 

EUPURPURIN    224 

GELSEMIN.    GELSEMININE  225 

GERANIN 229 

GLONOIN   229 

GOLD  ; 233 

GOSSYPIN    235 

GREGORY'S  SALT  236 

GUARANINE    236 

HAMAMELIN    237 

HELENIN    238 

HELONIN 240 

HYDRASTIN    241 

HYDRASTININE   , 245 

HYOSCINE  HYDROBROMATE  247 

HYOSCYAMINE    249 

IODOFORM  252 

IRIDIN 254 

IRON    256 

JALAPIN    261 

JUGLANDIN   262 

KOUSSEIN   264 

LECITHIN  265 

LEPTANDRIN   268 

LOBELIN    269 

LYCOPIN   271 

MACROTIN    272 

MENISPERMIN  274 

MENTHOL    275 

MERCURY   276 

MORPHINE   279 

MUSCARINE    284 

NARCEINE    285 

NARCOTINE   288 

NICKEL  BROMIDE  : 290 

NUCLEIN   292 

PAPAYOTIN    208 

PEPSIN 299 

PHYSOSTIGMINE    300 

PHYTOLACCIN  302 


CONTENTS. 

PAGE 

PICRIC  ACID  303 

PlCROTOXIN     305 

PlLOCARPINE     306 

PlPERINE     311 

PODOPHYLLIN.     PoDOPHYLLOTOXIN    312 

POPULIN     315 

POTASSIUM  BICHROMATE  315 

POTASSIUM  PERMANGANATE  316 

QUASSIN 317 

QUININE   320 

RESORCIN    327 

RHEIN    327 

RHUS  Tox  329 

RUMICIN    333 

SALICIN.    SALICYLIC  ACID  333 

SANGUINARINE  337 

SANTONIN    338 

SCILLITIN    340 

SCUTELLARIN    342 

SENECIN    342 

SODIUM  SUCCINATE  344 

SPARTEINE   345 

STROPANTHIN  346 

STRYCHNINE  347 

VERATRINE 354 

VERBENIN   362 

VIBURNIN   363 

XANTHOX YLIN    365 

YOHIMBINE  366 

ZINC  CYANIDE  368 

ZINC  OXIDE 371 

ZINC  PHOSPHIDE  371 

ZlNC  SULPHOCARBOLATE  375 

ZINC  VALERIANATE   378 


A     TEXT-BOOK 


ALKALOIDAL    THERAPEUTICS 


ACONITINE. 

Standard  granules — Aconitine  amorphous,  alk.,  gr.  1-134,  gm.  .0005 ;  aconi- 
tine  amorphous,  alk.,  gr.  1-500,  gm.  .000125;  aconitine  cryst.  alk.,  gr.  1-500, 
gm.  .000125. 

Aconitine  was  discovered  by  Geiger  and  Hesse  in  1833.  It  oc- 
curs in  crystalline  and  in  granular  form.  It  is  permanent  in  the  air, 
odorless,  the  taste  bitter  at  first,  then  sharp  and  tingling.  When 
yellow  it  is  impure  and  the  taste  is  more  burning.  It  is  soluble  in 
alcohol,  ether,  chloroform  and  hot  water.  It  is  absorbed  from 
chloroform  solution,  or  from  wounds,  ulcers  or  abrasions.  £or 
hypodermic  use  the  nitrate  is  best,  being  quite  soluble  in  water.  The 
injections  are  very  painful.  Aconitine  is  found  in  Aconitum 
napellus,  ferox,  japonicum,  and  many  other  species,  five  of  which 
are  found  in  America. 

Merck  gives  the  formula  as  C33  H43  N  O12. 

Duquesnel's  method  of  extraction  is  as  follows :  100  parts  of 
powdered  aconite  root  are  mixed  with  one  part  of  tartaric  acid ;  this 
is  exhausted  by  repeated  percolation  with  cold  alcohol,  and  the 
liquid  evaporated  at  a  low  temperature  on  a  water  bath  to  the  con- 
sistence of  a  fluid  extract.  To  this  is  added  distilled  water,  and  the 
precipitated  resinous  and  oily  matter  removed  by  filtration.  The 
resultant  solution  of  aconitine  tartrate  is  then  precipitated  with  a 
slight  excess  of  potassium  bicarbonate,  agitated  with  washed  ether 
and  the  two  fluids  separated  with  the  siphon.  The  ethereal  solution 
is  shaken  four  or  five  times  with  a  ten  per  cent  solution  of  hydro- 
chloric acid,  which  takes  up  the  alkaloid  from  the  ethereal  solution. 
The  acid  liquids  are  treated  with  calcium  carbonate  to  saturation,  to 
prevent  the  acid  injuring  the  aconitine ;  the  mixture  is  evaporated  at 
a  very  gentle  heat,  filtered,  and  while  still  warm  mixed  with  a  solu- 
tion of  sodium  nitrate  (2  of  salt  to  3  of  water),  having  the  same 
temperature.  The  whole  is  allowed  to  cool  slowly  during  several 


2  ACONITINE 

hours  and  set  away  for  several  days'  rest,  when  the  crystals  separate 
out  as  a  crust  on  the  bottom. 

Van  Renterghem  gives  the  following  as  the  total  daily  dose  of 
several  aconitines : 

Duquesnel's .gr.       1-20 

Merck's  crystallized gr.       1-2.2. — 1-17 

Merck's  amorphous gr.     I 

Chanteaud's  granules gr.       5-6 

Friedlaender's   gr.  15 

Merck  gives  the  following  single  dosage : 

Aconitin  (Eclectic  resinoid)  0.003 — 0.005.  Aconitine  pure, 
crystal,  o.oooi — 0.00035;  single  maximum  o.oooi,  daily  0.003. 
Aconitine,  pure  amorph.,  o.ooi.  Aconitine  from  A.  Ferox,  0.00026 
— 0.00065. 

The  arsenate,  hydrobromate,  hydrochlorate,  nitrate,  phosphate, 
salicylate  and  sulphate  are  listed ;  doses  same  as  of  the  alkaloid. 

Physiologic  and  Toxic  Actions.  — i.  The  sensory  nerve- 
ends  are  first  stimulated,  with  tingling,  warmth,  sneezing,  salivation, 
coughing,  vomiting,  neuralgic  pain ;  later  comes  paralysis  of  tac- 
tile, pain  and  special  sensation.  The  fifth  cranial  nerve  is  especially 
affected,  the  tongue,  lips  and  cheeks;  the  other  nerves  in  the  order 
of  their  sensibility,  those  of  the  face,  perineum,  breast,  belly  and 
lastly  the  back. 

2.  The  motor  nerves  are  probably  unaffected,  as  well  as  the 
muscles ;  the  fibrillary  twitching  being  possibly  due  to  irritation  of 
the  intramuscular  nerve-ends.     The  weakness  may  be  attributed  to 
the  feeble    circulation    and    innutrition.      When    applied    directly, 
aconitine  abolishes  the  irritability  of  all  nerve-fiber. 

3.  The  vasomotor  medullary  center  is  first  stimulated  and  then 
depressed;  the  nerves  and  ends  are  unaffected.     Arterial  tension  is 
lowered,  the  vessels  containing  less  blood. 

4.  The  mental  faculties  are  not  directly  affected,  but  may  be- 
come clouded  by  carbonic  acid  poisoning. 

5.  The  vagus  inhibitory  center  is  strongly  stimulated,  slowing 
the  heart  and  prolonging  the  diastole,  the  work  done  by  each  systole 
is  notably  increased,  the  auricles  continue  to  beat  after  the  ventricles 
have  ceased,  their  rhythm  becoming  disassociated.     In  lethal  doses 
the  stimulation  of  the  intracardiac  inhibitory  apparatus  may  exceed 
or  outlast  the  stimulation  of  the  center,  and  the  heart  beats  rapidly 
and  irregularly,  passing  into  "cardiac  delirium." 


ACONITINE  3 

6.  The  respiratory  center  is    directly    depressed,    breathing  is 
slowed,  expiration  labored,  the  accessory  m,uscles  being  called  into 
prominent  use ;  dyspnea  occurs,   the  respirations  become  shallow, 
and  death  occurs  by  asphyxia.    Convulsions  may  precede  death. 

7.  The  temperature  falls,  either  from  the  normal  or  in   fever. 
The  fall  is  increased  by  cold,  retarded  by  heat.    This  effect  may  be 
due  in  part  to  a  direct  effect  upon  the  heat-regulating  center. 

8.  The  saliva  is  increased  by  direct  irritation ;  the  perspiration 
as  a  symptom  of  depression.    Other  secretions  are  increased  doubt- 
fully. 

9.  Oxidation  is  unaffected. 

10.  The  pupil  is  first  contracted,  then  dilated  widely. 

11.  Aconitine  is  rapidly  absorbed  by  the  tissues,  disappearing 
from  the  blood.     It  is  excreted  by  the  kidneys,  traces  appearing  in 
the  bile  and  saliva. 

Atropine  antagonizes  the  vagus  inhibition  and  by  sustaining 
respiration  may  save  life  when  a  lethal  dose  has  been  taken.  But  if 
the  dose  of  aconitine  be  sufficiently  large,  death  will  still  occur  from 
heart-paralysis. 

In  physiologic  doses  aconitine  relaxes,  and  slows  the  pulse  and  > 
respiration,  lowers  the  temperature  and  the  vascular  tension,  equal- 
izing the  circulation  and  dissipating  hyperemia. 

In  toxic  doses  it  causes  tingling  of  the  skin  followed  by  anes- 
thesia, salivation,  slow  labored  respiration,  the  pulse  slow  and  soft 
until  imperceptible,  with  nausea  and  vomiting,  and  muscular  de- 
bility, the  symptoms  of  collapse  supervening.  Convulsions  may  oc- 
cur, the  pupils  dilate  and  death  ensues  from  asphyxia.  The  pulse 
may  become  irregular  and  rapid  before  death. 

Locally,  aconitine  causes  tingling  of  the  tongue,  throat,  or  any 
part  to  which  it  is  applied.  This  is  the  diagnostic  evidence  of  its 
presence. 

Cash  states  that  aconitine  alters  the  cardiac  rhythm,  in  certain 
large  doses  the  ventricular  systole  having  no  corresponding  auricular 
contraction.  Ventricular  delirium  precedes  death. 

Benzaconine  does  not  cause  tingling  or  numbness ;  it  slows  the 
heart-beat  astonishingly,  but  a  ventricular  systole  often  has  two  or 
three  auricular  contractions  preceding  it.  This  is  the  reverse  of  what 
obtains  from  aconitine.  Absolute  cardiac  quiet  for  a  time,  shows 
interference  with  the  cardiac  motor  impulses.  Blood-pressure  is 
reduced,  but  benzaconine  is  lethal  through  asphyxia.  It  scarcely  af- 
fects the  sensory  nerves  but  depresses  the  motor,  and  checks  muscu- 


lar  contraction.  The  temperature  is  not  much  depressed.  Dose, 
200  times  that  of  aconitine,  or  0.02. 

Aconine  causes  neither  numbness  nor  salivation.  It  strengthens 
the  ventricular  systole  and  antagonizes  the  incoordination  of 
aconitine.  In  very  large  doses  it  depresses  respiration  and  suspends 
the  function  of  the  motor  nerves-.  Dose,  2000  times  that  of 
aconitine,  or  0.2. 

Toxicology. — The  beginning  of  aconitine  poisoning  is  denoted 
by  the  sensation  of  coolness  at  first,  then  horripilations  in  the  back, 
heaviness  of  the  limbs?  tension  and  numbness  of  the  face. 

Taking  fractional  doses  of  the  alkaloid,  continued  at  intervals, 
we  experience  successively  the  following  symptoms;  numbness  and 
tingling  of  the  tongue,  extending  to  the  lips,  less  to  the  cheeks,  the 
root  of  the  nose,  the  forehead;  oppression  in  the  temples,  light 
frontal  headache;  tingling  in  the  hands,  forearms  and  thighs,  espe- 
cially on  the  outer  side ;  coolness  and  bristling  in  the  back ;  the 
face  is  red;  a  sense  of  excitement  like  light  alcoholic  inebriety;  ap- 
petite normal,  often  even  more  than  usual. 

Diuresis  is  a  little  increased,  as  well  as  the  intestinal  peristalsis, 
without  influencing  the  stools. 

The  brain  is  unaffected,  and  the  patient  can  work  without  dif- 
ficulty. 

The  night  following  the  day  of  experimentation  is  calm,  sleep 
excellent,  and  on  awaking  all  traces  of  aconitism  have  disappeared. 

The  pulse  oscillates  between  84  and  70,  the  temperature  between 
99.7°  and  98.6°  F. 

Sphygmographic  tracings  give  no  result  of  value,  the  drug  be- 
ing taken  within  physiologic  limits. 

Van  Renterghem  found  the  minimum  dose  to  produce  a  decided 
effect  to  be  %  to  l/2  milligram  of  crystallized  aconitine,  or  10  to  15 
milligrams  of  the  amorphous ;  while  the  total  dose  for  twelve  hours 
was  3^  milligrams  of  the  crystallized  and  60  milligrams  of  the 
amorphous. 

The  effects  of  a  lethal  dose  are  thus  described  by  Hookma 
Tresling:  "A  colleague  had  taken  3.6  milligrams  of  crystallized 
aconitine,  substituted  by  the  druggist  for  Friedlander's.  a  very  weak 
preparation.  The  dose  was  taken  at  4:30  p.  m.,  just  after  a  meal. 
At  5  130  the  doctor  found  himself  ill.  He  was  pale,  could  hold  him- 
self erect  with  difficulty,  mind  clear;  8  p.  m.,  pulse  small,  very  ir- 
regular, normal  rate;  skin  cool,  pupils  contracted.  He  complained 
of  painful  muscular  contractions,  especially  of  the  mouth,  burning 


ACONITINE  5 

of  the  tongue  and  oppression  in  the  abdomen,  precordial  anxiety, 
difficult  deglutition,  loss  of  taste,  swelling  of  the  tongue,  great  dif- 
ficulty in  moving  or  sustaining  himself.  Intense  headache. 
Sensorium  perfectly  clear. 

"Camphor,  coffee  and  cognac  were  administered,  also  digitalis, 
with  mustard  to  the  extremities. 

"  'Good  God !  How  cold  I  am,'  said  he,  repeatedly.  In  effect,  the 
skin  was  like  ice,  especially  the  extremities. 

"He  cried,  'I  can  see  no  longer!'  At  that  moment  his  pupils 
were  dilated ;  they  contracted,  and  his  sight  returned.  The  per- 
manent disquiet  was  characteristic.  He  then  vomited,  first  spitting 
up  much  mucus  from  the  throat.  Constantly  he  complained  of  the 
head  and  the  epigastrium.  At  8 140  he  had  the  first  convulsions,  be- 
ginning with  redness  of  the  face  and  conjunctiva,  bright  eye,  then 
foam  on  the  lips,  then  involuntary  movements  of  the  legs  and  face, 
breath  stertorous  and  painful.  The  paroxysm  was  short.  When 
over,  he  asked  what  had  happened  and  spoke  of  buzzing  in  his  ears, 
deafness,  and  heaviness  of  the  head. 

"Ether  was  then  injected.  He  rolled  up  his  .own  sleeve.  The  in- 
jection gave  him  pain.  Immediately  he  cried  again,  'How  cold  I 
am,  I  see  nothing,  colleague.'  Pupils  much  dilated,  repeated  vomit- 
ing; second  access  of  convulsions,  more  severe  and  prolonged  than 
the  first.  He  returned  to  himself  but  was  exhausted.  Seeing  the 
girl  who  aided  us  weep,  he  said,  'Don't  cry,  I'll  be  better  soon.' 

"With  difficulty  I  made  him  swallow  some  coffee  and  cognac.  The 
pulse  seemed  less*  feeble.  He  said  his  head  was  on  fire  and  he  could 
not  see.  He  uncovered  his  arm  for  an  ether  injection,  and  was 
solicitous  about  causing  trouble. 

"At  8:53  P-  m->  enormous  vomiting  occurred,cold  sweat,the  third 
series  of  convulsions  closed  the  scene.  After  this  he  did  not  recover 
consciousness' ;  the  pupils  were  dilated,  insensible  to  light ;  respiration 
light  and  difficult.  Galvanism  was  applied  without  benefit.  Res- 
piration weakened,  the  pulse  became  imperceptible,  the  heart  stop- 
ped, and  he  died  at  9  p.  m.,  four  and  one-half  hours  after  taking 
the  fatal  dose." 

There  is  no  evidence  that  the  stomach  was  washed  out  or 
atropine  or  strychnine  administered. 

In  other  cases  the  following  additional  symptoms  were  noted : 
Dicrotic  pulse,  eructations  of  gas,  mental  confusion,  frontal  and 
facial  pains  augmented  by  the  least  exercise  of  the  brain,  dyspnea, 
pollutions,  .vertigo,  rarely  somnolence. 


6  ACONITINE 

From  the  foregoing  description  it  will  be  readily  under- 
stood that  the  picture  of  aconitine  poisoning  is  a  complicated  one; 
if  a  sufficient  dose  has  been  taken  the  entire  central  and  peripheral 
nervous  system  will  be  affected  and  in  no  well-defined  manner.  Thus 
one  case  will  present  one  set  of  urgent  symptoms  and  the  next 
another.  As  it  is  not  impossible  for  the  practician  to  get  a  case  of 
accidental  poisoning  from  the  chewing  or  swallowing  in  some  man- 
ner of  the  root  or  other  portions  of  the  larkspur  or  monkshood 
plants,  which  are  fairly  common  in  gardens,  he  should  remember 
that  the  most  likely  symptoms  will  be  nausea,  retching,  with  ex- 
cessive salivation,  burning  of  the  mouth  and  fauces,  and  diarrhea. 
Next  may  appear  muscular  weakness,  slow,  weak  heart,  and  the 
tingling  and  burning  pass  away  as  the  stage  of  anesthesia  begins. 
At  this  period  there  is  apt  to  be  great  restlessness.  Incoodination, 
vertigo,  lividity  and  coldness  of  the  surface,  mark  this  stage — which 
is  usually  the  second  one  though  if  any  large  amount  of  the  poison 
has  been  taken  it  may  be  the  first  apparent.  The  ingestion  of  a  still 
larger  quantity  usually  means  almost  "sudden  death,"  from  failure 
of  the  heart-action,  that  organ  being  speedily  paralyzed.  In  the 
ordinary  case,  however,  death  is  more  apt  to  come  from  respiratory 
than  cardiac  failure,  and  convulsions  in  this  condition  are  not  un- 
common. Speech  and  the  special  senses  may  be  affected,  though  in- 
telligence usually  remains  unimpaired  to  the  end.  The  drug  has 
been  used  of  late  for  suicidal  purposes,  but  the  symptoms  are  so  un- 
mistakable as  a  rule  that  it  is  not  a  favorite  with  criminals.  The 
symptoms  of  aconitine  poisoning  may  appear  within  five  minutes 
and  are  seldom  delayed  more  than  half  an  hour.  Heat  is  essential 
in  the  treatment,  and  the  heart  and  respiration  must  be  supported  by 
heroic  measures  during  the  attempts  at  elimination,  which  should 
always  be  made. 

Therapeutics. — The  chief  therapeutic  indication  for  aconitine 
is  the  presence  of  hyperemia,  or  active  congestion,  the  first  stage  of 
inflammation.  The  reason  for  the  use  of  this  agent  lies  in  its  power 
of  reducing  the  heart-action,  lessening  the  quantity  of  blood  thrown 
into  the  arteries,  and  of  relaxing  the  vasomotor  spasm  in  the  skin 
and  elsewhere,  allowing  the  blood  to  flow  back  into  these  channels 
and  thus  reducing  the  over-supply  in  the  hyperemic  area.  It  is 
therefore  in  the  first  stage  of  all  inflammatory  attacks  that  aconitine 
is  to  be  administered,  in  small  doses  rapidly  pushed  until  the  full 
physiologic  effects  are  manifested.  The  earlier  the  remedy  is  given, 
the  more  effective  it  will  be.  Pleurisy,  pneumonia,  bronchitis, 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


ACONITINE  7 

peritonitis  and  local  inflammations  everywhere,  demand  this  treat- 
ment. 

When  consolidation  has  occurred  in  pneumonia,  aconitine  cannot 
be  expected  to  dissipate  the  disease  and  cause  the  return  of  effused 
materials  to  the  blood ;  but  along  the  margin  of  the  hepatized  tract 
there  is  a  zone  of  hyperemia,  by  which  the  affection  gradually  ex- 
tends into  the  surrounding  tissue.  This  is  favorably  influenced  by 
aconitine,  hence  we  find  it  useful  through  the  stage  of  hepatization, 
as*  well  as  in  moderating  the  heart-action  when  excessive  and  re- 
lieving the  engorgement  of  blood  in  the  unaffected  portions  of  the 
lungs. 

In  specific  fevers  aconitine  is  most  useful  as  a  palliative,  keeping 
the  heart-action  and  fever  from  becoming  excessive,  moderating  the 
symptoms  though  it  may  not  affect  the  microbic  causes. 

The  dose  of  Merck's  amorphous  aconitine,  the  best  for  use,  is  one 
to  three  milligrams,  for  an  adult,  repeated  every  ten  to  sixty  minutes 
till  the  effect  is  evident,  then  as  necessary  to  sustain  the  effect.  It 
is  always  best  to  give  aconitine  in  solution,  to  insure  quick  absorp- 
tion. To  children  it  may  be  given  by  Shaller's  rule:  One  granule, 
gr.  1-134,  for  each  year  of  the  child's  age,  and  one  extra  "for  the 
glass,"  in  twenty-four  teaspoonfuls  of  water;  the  dose  of  this  solu- 
tion being  one  teaspoonful  every  ten  to  sixty  minutes.  For  children 
under  one  year,  the  best  plan  is  to  divide  the  dose  by  the  weight. 
A  child  at  one  year  averaging  15  pounds,  the  dose  for  a  year  may 
be  divided  by  the  child's  weight,  so  that  a  child  weighing  7^/2 
pounds,  receives  one-half  the  yearling's  dose,  regardless  of  the  age. 
In  the  vast  field  of  febrile  disease  aconitine  holds  the  first  place  as 
an  antipyretic.  As  soon  as  the  bowels  have  been  emptied  and  rendered 
aseptic,  aconitine  should  be  administered  in  doses  of  one  milligram 
(o.ooi)  every  ten  to  sixty  minutes*,  until  the  fall  of  temperature, 
slowing  of  the  pulse  and  other  indications  show  that  the  full  physi- 
ologic effect  has  been  secured,  after  which  the  doses  are  repeated 
often  enough  to  keep  up  the  desired  effect.  The  relaxation  of 
arterial  tension  affords  relief  to  the  heart,  removing  one  of  the 
principal  obstacles  it  has  to  overcome.  Digitalin  is  frequently  added 
to  steady  the  heart,  veratrine  to  stimulate  the  eliminant  apparatus, 
and  strychnine  arsenate  to  increase  vitality. 

In  sudden  congestions  from  exposure  to  cold  and  wet,  with  con- 
sequent chills,  headache,  stoppage  of  menstruation,  etc.,  the  prompt 
use  of  aconitine  will  generally  restore  the  circulatory  equilibrium 
and  bring  back  the  flow,  averting  a  serious  illness. 


8  ACONITINE 

In  neuralgic  maladies  we  have  usually  vasomotor  spasm  of  the 
cutaneous  capillaries,  the  skin  pale,  cool  and  shrunken,  the  pulse 
small  and  tense.  Here  also  aconitine  exerts  a  most  prompt  and  fav- 
orable action,  restoring  the  blood  to  the  skin  and  relieving  congested 
nerve  centers. 

In  gastrointestinal  maladies  aconitine  is  of  great  value,  subduing 
the  local  congestion  and  promoting  resolution.  In  fact,  to  enumerate 
all  the  maladies  in  which  aconitine  is  useful  would  be  to  list  nearly 
all  the  maladies  to  which  humanity  is  heir. 

In  all  cases,  it  is  necessary  that  the  physician  comprehend  exactly 
the  effect  he  desires,  and  that  the  doses  be  given,  in  frequency  pro- 
portioned to  the  acuteness  of  the  attack  and  the  need  for  haste,  until 
the  desired  effect  is  manifest.  In  general,  a  temperature  fall  to  or 
below  102  should  be  secured  and  a  pulse  not  over  90,  before  the 
remedy  is  to  be  given  less  frequently;  but  if  the  fever  is  evidently 
subdued,  the  patient  sweating,  pain  relieved,  pulse  soft,  the  time  for 
less  frequent  dosage  has  arrived.  Few  nurses  fail  to  comprehend 
this  simple  direction :  Give  the  medicine  less  frequently  after  the 
fever  breaks ;  just  enough  to  keep  it  down. 

Amorphous  aconitine  has  been  used  by  many  thousands  of  Amer- 
ican physicians  in  the  past  seven  years.  One  house  has  in  that  time 
sent  out  more  than  20,000,000  granules  of  this  alkaloid,  and  not  a 
solitary  case  of  fatality  or  of  alarming  toxic  symptoms  has  been  re- 
ported from  its  use.  On  the  other  hand  the  activity  of  these  granules 
may  be  readily  tested  by  allowing  one  to  dissolve  in  the  mouth,  when 
the  numbness  appears  promptly.  In  view  of  this  statement,  the 
superstitious  dread  with  which  this  alkaloid  has  been  regarded  by 
many,  may  be  safely  laid  aside. 

Van  Renterghem,  speaking  of  synergists  and  antagonists,  says: 
"In  its  excito-motor  action  aconitine  acts  in  harmony  with  strych- 
nine, brucine,  caffeine  and  quinine ;  while  in  other  respects  it  finds 
synergists  in  veratrine,  colchicine  and  delphinine.  It  has  no  true 
antagonists."  The  secondary  action  of  aconitine  upon  the  cardiac 
functions  may  be  opposed  by  curarine,  or  by  atropine;  which,  par- 
alyzing the  inhibitory  fibers  of  the  pneumogastric,  suppress  the  ac- 
tion of  aconitine.  These  two  agents  are  but  partially  antagonists 
(Laborde  and  Duquesnel). 

Van  Renterghem  says  that  aconitine,  by  its  sedative  action  on  the 
vasomotor  centers,  slowing  the  pulse  and  the  heartbeat,  oc- 
cupies the  first  rank  among  def ervescents ;  while  its  power  of  re- 
ducing the  caliber  of  the  capillaries  makes  it  the  antiphlogistic  par 


ACONITINE  9 

excellence.  By  its  use  losses  of  blood  can  be  stopped,  while  its 
anesthetic  power  over  the  nerves  of  sense  gives  it  an  honorable  place 
as  an  antineuralgic.  With  strychnine  and  digitalin,  Burggrseve 
pronounces  it  invaluable  as  a  preventive  of  fever  and  inflammation, 
in  puerperal  and  surgical  cases.  He  gives  it  in  the  evening,  to  pre- 
vent or  moderate  the  physiologic  evening  rise,  and  insure  rest. 
This  he  terms  "equilibrating  the  physiologic  balance."  Van  Renter- 
ghem  finds  aconitine  of  value  in  breaking  up  forming  catarrhs  and 
quinsies.  With  digitalin  it  is  a  powerful  diuretic.  With  veratrine 
it  combats  fevers  in  the  sthenic  forms ;  it  i&  combined  with  quinine 
in  malaria,  with  digitalin  for  irregular  hearts  in  acute  maladies,  with 
caffeine  in  somnolence  and  torpor,  with  strychnine  to  prevent  depres- 
sion and  arouse  vitality.  It  calms  agitation,  delirium,  insomnia  and 
nervousness.  In  alcoholic  delirium  it  acts  like  magic  when  combined 
with  digitalis,  strychnine  or  hyoscyamine  or  morphine.  In  the  de- 
liriums met  among  the  insane  it  is  of  like  benefit.  As  an  anti- 
neuralgic  aconitine  has  marvelous  success  with  hyperemic  forms ; 
not  only  in  trigeminals  but  in  neuropathies  of  central  origin.  It 
relieves  toothache,  even  by  inserting  a  granule  in  a  carious  cavity, 
alone  or  with  one  of  hyoscyamine.  In  diathetic  neuralgias  the  ap- 
propriate remedy  must  be  given  with  the  aconitine,  such  as  quinine, 
arsenic,  iodine,  salicylates,  etc.  In  chronic  cases,  catarrhal  asthma, 
rheumatism,  arthritic  pains,  old  neuralgias,  congestive  amaurosis, 
associate  it  with  iron,  arsenic  or  zinc.  It  is  efficacious  in  epilepsy 
and  chorea  (Burggrseve).  Visceral  hyperemias  call  equally  for 
aconitine  (Laura).  It  cures  tinnitus  aurium. 

Brunton  enumerates  among  maladies  in  which  aconitine  is  useful, 
pleurisy,  pneumonia,  phthisis,  peritonitis,  pericarditis,  rheumatic 
fever,  gout,  erysipelas,  otitis,  gonorrhea  and  urethral  fever ;  also 
the  neuralgia  accompanying  herpes  zoster,  amenorrhea  from  a  sud- 
den check  of  the  flow,  and  severe  menorrhagia. 

Butler  says  aconite  seems  to  exert  a  peculiarly  beneficial  influ- 
ence on  acute  mucous  inflammations,  with  fever,  small  wiry  pulse 
and  rapid  heart-action.  He  finds  it  most  efficient  in  irritative  fevers 
of  children.  Thrown  into  the  rectum,  it  causes  slight  prolapse  and 
quickly  affects  an  irritable  urethral  stricture,  facilitating  catheter- 
ism.  It  has  been  recommended  in  cerebrospinal  fever;  and  in 
aneurism  as  a  sedative. 

Murrell  pronounces  aconite  invaluable  in  the  initial  stage  of  all 
acute  fevers.  In  the  eruptive  fevers  it  brings  out  the  rash  and 
mitigates  the  subsequent  severity. 


10  ^SCULIN 

Shoemaker  states  that  aconitine  ointment  will  often  assuage  the 
pain  of  chronic  rheumatism,  gout  and  myalgia,  cutaneous  neuralgias, 
paresthesiae,  pruritus,  papular  eczema  and  prurigo.  Jonathan 
Hutchinson  found  it  mitigated  the  pains  of  carcinoma,  and  also  em- 
ployed it  in  rheumatic  iritis,  acute  congestion  of  the  brain  and  spas- 
modic croup.  It  is  said  to  antidote  the  sting  of  the  scorpion.  It 
relieves  the  pain  of  epididymitis  and  gives  much  relief  in  tobacco 
heart. 

Ringer  says  that  spinal  irritation,  intercostal  neuralgia  and 
sciatica  yield  to  aconitine  ointment,  but  more  readily  to  belladonna 
(excepting  sciatica).  Its  power  to  control  inflammation  and  subdue 
fever  is  remarkable.  Aconite  at  once  arrests  post-vaccinal  inflam- 
mation ;  it  checks  epistaxis,  subdues  fluttering  of  the  heart,  quiets 
"fidgets,"  and  is  said  to  remove  chordee. 

Wood  considers  aconite  the  best  remedy  for  cardiac  hypertrophy, 
simple  and  compensative. 

Ellingwood  recommends  aconite  in  acute  nephritis  and  cystitis, 
in  the  inflammatory  stage  of  dysentery  and  cholera  infantum,  in  the 
onset  of  diphtheria  and  croup,  and  in  acute  mastitis.  It  heightens 
the  effects  of  cimicifuga,  belladonna,  veratrum,  gelsemlum  and  as- 
clepias. 

Scudder  applies  the  tincture  over  the  eyebrows  in  acute  con- 
junctivitis with  photophobia ;  and  uses  it  locally  also  in  earache. 

^SCULIN. 

Standard  granule — Gr.  1-67,  gm.  .001. 

From  the  horse  chestnut,  ./Esculus  hippocastanum,  is  derived 
^Esculin,  a  bitter  glucoside.  The  bark  yields  about  2  to  3  per  cent. 
In  the  galenic  preparations  aesculin  is  associated  with  several  other 
active  principles,  such  as  saponin,  which,  existing  in  variable 
amounts  and  proportions,  render  their  action  too  uncertain  for 
modern  medicine.  The  glucoside  has  not  been  extensively  employed 
but  from  the  meager  reports  upon  it  we  gather  what  follows : 

Therapeutics. — ^Bsculin  is  a  bitter  tonic  and  has  its  virtues. 
By  the  eclectics  it  is  valued  in  malarial  fevers  and  especially  in 
visceral  neuralgias,  when  abdominal  plethora  coexists.  It  is  not  a 
remedy  for  acute  conditions  but  for  chronic  capillary  stasis,  general 
vascular  fullness,  soreness  and  throbbing  with  malaise ;  uneasy,  full, 
aching  sensation  in  the  liver,  rectal  irritation  and  hemorrhoids,  with 
constriction  and  congestion,  spasmodic  closure  of  the  sphincter,  itch- 


AGARICIN  11 

ing,  heat,  pain  or  simply  uneasiness.  The  piles  are  large,  purple,  do 
not  bleed,  but  there  may  be  diarrhea.  ^Esculin  relieves  these  condi- 
tions and  also  rectal  neuralgia  and  proctitis  dependent  thereon,  as 
well  as  such  reflexes  as  dyspnea,  asthma,  vertigo,  headache,  back- 
ache, etc.  (King). 

As  aesculin  relieves  the  rectal  affection  these  difficulties  subside. 

^sculin  is  soluble  in  672  parts  of  cold  water,  12.5  of  boiling  wa- 
ter and  in  24  parts  of  alcohol.  The  dose  for  periodic  fevers  is  5 
to  30  grains,  but  for  hepatic  obstructions  it  is  recommended  in  very 
much  smaller  doses.  Possibly  gr.  1-67  to  1-6  every  hour  will  give 
the  best  results. 

AGARICIN. 

Standard  granules — Gr.  1-67,  gm.  .001 ;  gr.  1-12,  gm.  .005. 

Agaricin  or  agaricic  acid,  C14  H27  (OH)  (COOH)2,  is  derived 
from  the  Boletus  laricis,  or  larch  fungus.  Known  also  as  Polyporus 
officinalis.  The  fungus,  which  is  of  horse-shoe  shape,  is  gathered  in 
September  and  August.  Agaricin  is  obtained  in  silvery,  lustrous 
crystals,  tasteless,  soluble  in  ten  parts  of  hot  alcohol,  in  130  parts 
of  cold ;  insoluble  in  cold  and  slightly  in  hot  water,  ether  or  chloro- 
form. Jahns  obtained  agaricic  acid  by  submitting  white  agaric  to 
the  action  of  hot  alcohol.  The  product  was  16  to  18  per  cent,  mixed 
with  4  per  cent  of  a  crystalline  matter,  3  per  cent  of  an  amorphous 
white  substance,  and  30  per  cent  of  a  purgative  resin.  Fleury  re- 
duced the  agaric  to  powder,  and  treated  it  with  absolute  anhydrous 
ether,  obtaining  an  amorphous  resin  and  agaricin  in  very  fine  needle 
crystals. 

Physiologic  and  Toxic  Actions. — Agaricin  and  its  sodium  salt 
irritate  the  mucosa  and  may  cause  suppuration  if  injected.  Large 
doses  cause  vomiting  and  purging,  especially  if  the  agaricin  is  im- 
pure, containing  resinous  matter.  In  toxic  dose  injected  intraven- 
ously, agaricin  first  stimulates  and  then  paralyzes  the  medulla,  the 
blood-pressure  rising  and  then  falling,  the  heart  first  slowed  by  in- 
hibition, then  regaining  its  rythm,  finally  failing  after  the  arrest  of 
respiration  (Cushny).  The  arrest  of  perspiration  is  due  to  action 
on  the  peripheral  nerve-ends,  as  with  atropine,  but  agaricin  acts  only 
on  the  sweat-glands  and  has  none  of  the  disagreeable  effects  of 
atropine  on  the  pupil,  mouth  and  skin.  It  is>  used  only  as  a  remedy 
for  sweating,  especially  the  night-sweats  of  consumption.  It  is  less 
effective  in  miliary  tuberculosis  (Liebreich).  It  has  no  effect  on  the 


12  AGARICIN 

pulse,  temperature  or  respiration.  In  non-tubercular  affections 
agaricin  is  almost  always  effective  in  checking  profuse  perspiration. 
Pure  agaricic  acid  is  soluble  in  oil  of  turpentine,  and  might  be  thus 
given  with  advantage  in  typhoid  fever.  It  should  be  given  in  a 
single  dose,  five  hours  before  the  time  for  the  expected  perspiration. 
The  patient  soon  becomes  accustomed  to  agaricin  and  the  dose  must 
be  increased.  No  bad  effects  have  been  recorded  from  its  continued 
use.  Atropine  antagonizes  agaricin,  o.oi  (gr.  1-6)  of  agaricin  fairly 
counteracting  0.0005  (gr.  1-134)  of  atropine  ( Proebsting) . 

Therapeutics.— Merrell  recommends  agaric  in  obstinate  remit- 
tents, with  brief  chills  and  prolonged  fever,  little  or  no  sweating,  but 
jaundice,  aching  back  and  joints.  Small  doses  should  be  given. 

Kopp  found  it  especially  valuable  in  restraining  the  copious 
sweating  of  arthritics ;  and  Grant  claimed  for  agaric  antirheumatic 
properties.  The  older  writers  seemed  at  sea  as  to  the  cathartic 
effect  of  agaric,  numerous  contradictory  statements  appearing  in 
their  pages.  Gubler  even  contradicts  himself ;  for  while  he  attributes 
its  anhidrotic  effect  to  derivation  by  purgation,  he  says  that  this 
fungus  has  been  wrongly  ranked  with  the  drastics,  since  doses  of 
four  grams  may  be  given  without  purgative  effects. 

This  is  easily  explained,  as  the  purgative  principle  is  the  resin, 
while  the  anhidrotic  power  lies  in  agaricic  acid. 

Seyffert  pronounced  agaricin  as  efficacious  as  atropine  against 
hectic  sweats,  and  much  less  toxic. 

Proebsting  denied  that  four  hours  were  necessary  to  develop  the 
full  effect  of  agaricin,  which  he  found  to  act  very  promptly.  Prob- 
ably he  employed  a  purer  article. 

Van  Renterghem  advises  that  agaricin  be  alternated  with 
atropine  or  picrotoxin,  to  avoid  the  necessity  of  using  large  doses. 
Or,  these  agents  may  be  given  in  combination. 

Hofmeister  gives  the  dose  of  pure  agaricin  as  0.004 — °-°2  (gr- 
1-16—1-3). 

Merck  recommends  agaricin  in  doses  of  0.015 — 0.065  (gr.  % — 
i),  and  pure  agaricic  acid  preferably,  o.oi — 0.032  (gr.  1-6 — 1-2). 
He  speaks  favorably  of  its  use  for  sweating  from  overdoses  of  the 
coaltar  antipyretics. 

Briefly,  agaricin  is  anhidrotic,  antiperioclic,  a  stimulant  to  the 
nervous  system,  and  in  large  doses  cathartic  and  emetic — the  latter 
effects  should  never  be  produced  with  this  drug.  In  some  obscure 
aches  of  the  back  and  limbs  agaricin  will  give  prompt  relief. 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


ALETRIN.     ALNUIN  13 

ALETEIN. 

Standard  granule— Gr.  1-6,  gm.  or. 

Aletrin  is  a  concentration  from  the  rhizome  of  aletris  farinosa. 

This  drug  has  been  so  generally  confounded  with  helonias  that 
the  accounts  of  these  two  are  worthless,  and  both  must  be  restudied 
before  their  true  place  can  be  determined.  Aletrin  is  a  bitter  tonic, 
devoid  of  tannic  acid,  and  useful  in  atonic  dyspepsias,  vomiting  of 
pregnancy,  flatulence,  borborygmi,  wherever  a  mild  nonirritant  tonic 
is  required.  As  to  its  use  for  dysmenorrhea  and  other  affections  of 
the  female  reproductive  organs,  it  has  a  reputation  that  may  be 
deserved. 

The  dose  of  aletrin  may  be  placed  at  gr.  1-6  to  1-2  before  meals. 
For  dysmenorrhea  give  gr.  1-6  every  fifteen  minutes  in  hot  water 
till  relief. 

ALNUIN. 

Standard  granule — Gr.  1-12,  gm.  .005. 

Alnuin  is  a  concentration  from  the  bark  of  Alnus  serrulata,  the 
tag  alder.  The  bark  contains  tannic  acid,  oils  and  a  resin,  the  latter 
forming  the  bulk  of  alnuin. 

King  says  that  this  agent  powerfully  increases-  retrograde 
metamorphosis,  and  is  tonic  to  the  mucosa,  aiding  digestion  and  as- 
similation. It  is  catalytic  and  antiputrefactive.  It  increases  the 
flow  of  gastric  juice.  It  is*  alterative,  emetic  and  astringent. 

The  eclectics  recommend  alnuin  in  scrofula,  glandular  enlarge- 
ments and  suppurations,  superficial  diseases  of  the  skin  and  mucosa 
as  in  eczema  or  pustular  affections  (Scudder),  impetigo,  herpes, 
prurigo,  scurvy,  scurf  of  the  scalp  in  children,  boils,  passive  hemor- 
rhages, hematuria,  purpura  hemorrhagica,  marasmus,  mothers'  sore 
mouth,  indigestion  and  dyspepsia  with  deficient  secretion  of  gastric 
juice  and  gastric  motility,  diarrheas  attending  the  above  gastric 
condition,  leucorrhea,  mammary  indurations,  hay  fever  (Ayer), 
gonorrhea  and  rhus  poisoning.  Where  possible  it  should  be  em- 
ployed locally  as  well  as  internally.  The  specific  use  is  to  improve 
nutrition  and  increase  waste,  in  scrofula  and  scaly  or  pustular 
chronic  skin  diseases. 

We  have  found  this  drug  useful  for  women  who  are  sallow  and 
muddy  except  when  menstruating.  The  use  of  alnuin  clears  up  the 
complexion  and  renders  it  of  a  waxen  brilliancy. 

The  dose  is  gr.  */>  four  times  a  day,  increased  if  necessary  till 
effect. 


U  ALOIN 

Dr.  E.  F.  Bowers,  of  New  York,  gave  alnuin  with  potassium 
iodide  in  a  case  of  leg  ulcer  of  22  years'  standing,  with  local  anti- 
septics. A  cure  was  secured  in  three  months. 

Dr.  B.  S.  Home  considers  alnuin  superior  to  arsenic  as  a  remedy 
for  a  bad  complexion.  In  eczemas  with  feeble  vitality  he  finds  its 
effects  surprising.  Webster  mentions  a  Thompsonian  who  relied 
almost  wholly  on  alnus  in  all  chronic  affections  and  won  phenomenal 
success.  He  claims  for  it  a  special  affinity  for  the  skin,  influencing 
its  nutrition.  The  reports  point  to  the  remedy  as  increasing 
cutaneous  elimination  of  solids. 


ALOIN. 

Standard  granules — Gr.  1-12,  gm.  .005;  gr.  1-6,  gm.  .01. 

Aloin  is  obtained  from  the  Aloe  spicata,  Aloe  socotrina  and  Aloe 
vulgaris  (Nat.  Ord.  Liliaceae).  Hitherto  the  dried  juice  of  the 
leaves  was  the  preparation  used  in  medicine.  This  consists  of  aloin, 
aloetin  and  aloetic  resin,  all  cathartic,  with  a  small  proportion  of 
gallic  acid,  fat  and  albumin,  together  with  waste  matter. 

Aloin  is  obtained  by  evaporating  an  aqueous  extract  in  vacuo. 
It  occurs  in  small  colorless  crystals  of  sweetish  bitter  taste.  It 
forms  but  a  small  proportion  of  aloes.  It  is  inactive  in  the  bowels 
while  crystalline  (Schmiedeberg). 

Aloetin  is  an  amorphous  aloin,  and  is*  more  active.  It  forms  the 
bulk  of  the  aloes. 

Aloin  dissolves  freely  in  formamide,  in  60  parts  of  cold  water, 
20  of  alcohol,  in  hot  water  and  hot  glycerin,  in  the  latter  being 
transformed  into  aloetin.  It  belongs  to  the  aromatics,  since  with 
caustic  potash  it  splits  up  into  paraoxy, — benzoic,  acetic  and  oxalic 
acids. 

Physiologic  Action. — In  doses  of  o.oi — 0.06  (gr.  1-6 — i)  aloin 
increases  the  gastric  secretion  and  motility  (Liebreich). 

Nothnagel  denies  that  aloes  requires  bile  to  develop  its  cathartic 
activity,  though  he  states  that  aloes  and  oxgall,  or  aloin  and 
glycerin  (Kohlstock),  injected  into  the  rectum,  act  as  a  cathartic. 
Nor  does  he  admit  the  stomachic  and  digestive  powers  credited  to 
aloes.  But  in  these  respects  Liebreich  differs  with  him. 

In  doses  of  o.i — 0.5  (gr.  il/2 — 7^)  aloes  causes  eructations, 
gastric  oppression,  and  in  about  twelve  hours  several  dark,  mushy 


ALOIN  15 

stools,  usually  with  some  griping.  Three  times  this  dose  does  not 
cause  catharsis  more  quickly,  but  more  griping  and  rectal  tenesmus, 
and  the  stools  are  more  fluid.  Aloes  stimulates  peristalsis  strongly, 
especially  in  the  lower  bowel,  and  probably  increases  the  excretion 
of  bile,  by  a  similar  action  on  the  walls  of  the  gall-ducts.  The  con- 
tinued use  of  aloes  does  not  beget  tolerance,  but  the  contrary;  so 
that  when  given  continuously  the  dose  may  be  gradually  reduced, 
the  same  effect  being  manifested. 

Aloes  induces  an  afflux  of  blood  to  the  rectum,  uterus  and 
ovaries,  inducing  or  aggravating  an  existing  tendency  to  hemor- 
rhoids, hemorrhage  from  the  rectum  or  uterus,  abortion  or 
strangury,  and  it  strongly  stimulates*  the  sexual  appetite  and  func- 
tions. It  is  therefore  contraindicated  in  hemorrhoids,  pregnancy, 
menstruation,  erotism,  tendency  to  menorrhagia,  dysentery,  nephritis, 
cystitis,  and  all  pelvic  engorgements.  However,  this  does  not  apply 
to  hemorrhoids  with  atony  of  the  rectal  sphincter  and  prolapse,  in 
which  minute  doses  of  aloes  are  especially  useful. 

Aloin  is  actively  cathartic  in  doses  of  o.i — 0.2  (gr.  i^4 — 3), 
whether  administered  by  the  stomach,  the  rectum  or  subcutaneously, 
though  it  is  milder  when  given  hypodermically.  It  is  then  excreted 
into  the  bowel,  acting  locally  there  (Cushny).  In  large  doses  it  is 
violently  and  painfully  cathartic.  It  enters  the  blood,  as  the  milk 
of  a  nurse  taking  aloin  acts  on  her  nursling's  bowels. 

Aloin  differs  as  it  is  derived  from  the  various  forms  of  aloes 
brought  to  the  market,  the  Socotrine,  Cape,  Barbadoes  or  hepatic; 
the  former  being  probably  the  best.  It  occurs  in  small,  bright, 
sulphur-yellow,  prismatic  needles,  containing  J4  an  equivalent  of 
water. 

Therapeutics. — Aloes  possesses  the  unique  property  of  gradually 
increasing  the  tonicity  and  irritability  of  the  muscular  elements  of 
the  larger  bowel.  Given  in  doses  of  0.0x35 — 0.06  (gr.  1-12 — i)  three 
times  a  day,  or  o.ooi  (gr.  1-67)  every  hour  until  the  bowels  move, 
it  will  be  found  that  the  dose  found  sufficient  to  produce  a  daily 
action  can  be  gradually  diminished,  until  at  length  the  drug  can  be 
altogether  discontinued.  The  powerful  influence  of  habit  should  be 
secured,  the  patient  being  enjoined  to  go  to  the  closet  at  the  same 
hour  every  day.  The  tendency  to  griping  may  be  lessened  by  adding 
a  minute  dose  of  atropine,  while  the  peristaltic  action  is  enhanced  by 
strychnine,  the  irritability  by  capsicum.  The  following  granule  has 
proved  very  popular: 


16  ALOIN 

Aloetin gr.  1-67 

Strychnine  sulphate gr.  1-134 

Atropine  sulphate gr.  1-5000 

Capsicum  oleoresin gr.  1-67 

M.  S.  One  every  hour  till  the  bowels  move ;  or  three  to  six  be- 
fore each  meal. 

These  may  be  depended  upon  to  cure  any  case  of  chronic  con- 
stipation not  dependent  upon  mechanical  obstruction. 

Aloes  is  emphatically  a  remedy  for  small  doses,  frequently  ad- 
ministered. There  is  no  legitimate  use  of  this  drug  that  requires  a 
dose  larger  than  one  grain. 

When  hemorrhoids  of  long  standing  cease  to  bleed  and  symp- 
toms of  cerebral  hyperemia  appear,  aloes  will  give  relief  by  restor- 
ing the  hemorrhoidal  flux. 

Aloes  is  sometimes  employed  a&  an  emmenagogue  in  constipated, 
anemic  women  of  frigid  type,  with  scanty  flow.  It  is  also  added 
in  minute  doses  when  iron  or  other  constipating  drugs  are  ad- 
ministered. 

The  griping  caused  by  aloes  is  much  lessened  by  giving  it  after 
meals.  Cushny  suggests  that  the  bile  may  aid  the  action  of  purga- 
tives by  rendering  them  soluble,  or  by  delaying  the  solution  until 
they  reach  the  lower  bowel. 

King  says  that  aloin  purges  if  it  is  applied  to  the  surface  of  an 
ulcer  or  blister.  Kohlstock  found  the  solution  in  glycerin  or  in 
formamide  relieved  mild  constipation  when  applied  to  the  rectum, 
in  doses  of  gr.  vj  to  vijss.  But  this  degree  of  effect  would  result 
from  the  glycerin  alone. 

For  ascarides  the  aloetic  solution  should  be  injected  past  the 
sigmoid  flexure  into  the  colon,  as  these  parasites  flourish  near  the 
ileocecal  valve. 

In  chlorosis,  iron  should  be  combined  with  the  aloin ;  in  hysteria 
add  asafetida ;  in  amenorrhea  give  four  days*  before  the  time  for  the 
menses,  with  iron  and  myrrh ;  for  acholic  stools  add  podophyllin  or 
calomel ;  while  for  melancholy,  hypochondria,  and  the  group  of 
symptoms  usually  attendant,  give  with  intestinal  antiseptics,  and  see 
to  the  condition  of  the  prostatic  urethra.  For  chronic  atonic  diar- 
rheas give  the  smallest  doses,  gr.  1-12  or  less,  with  sulphur  and 
atropine,  also  in  small  doses. 

When  costiveness  is  the  cause  of  the  constipation,  aloes  can  do 
nothing  but  harm.  It  seems  to  have  little  or  no  good  effect  on 
flatulence,  which  is  a  surprise.  But  the  addition  of  quassin  and 
charcoal  makes  an  effective  combination. 


ANEMONIN  17 

ANEMONIN. 

Standard  granule — Anemonin,  true,  gr.  1-134,  gm.  .0005. 

Anemonin  is  the  active  principle  of  Anemone  pulsatilla  and  A. 
pratense.  Unless  the  plants  are  collected  soon  after  flowering-  the 
product  is  not  very  active. 

Anemonin  was  discovered  by  Heyer  in  1779. 

Van  Renterghem  gives  the  following  process  for  isolating 
anemonin :  Prepare  a  very  concentrated  infusion  of  anemone  in 
distilled  water,  and  leave  to  itself  for  many  weeks.  It  deposits  a 
white  substance,  that  is  to  be  purified  by  crystallizations  in  alcohol. 
This  gives  an  anemonin,  white,  crystalline,  neutral,  non-volatile  but 
evaporating  at  150  degrees. 

Anemonin  crystallizes  in  rhombic  crystals  and  needles,  heavier 
than  water.  There  is  little  taste  fo  it  at  first,  but  a  burning  later, 
this  lasting  some  days.  Volatilized  by  heat,  the  vapor  causes  a 
violent,  piercing  sensation  on  the  tongue,  leaving  where  it  touches 
numb,  white  spots.  The  eyes  and  nose  are  irritated.  It  decomposes 
in  air,  and  in  drying.  It  is  found  in  many  species  of  anemone 
(ranunculus).  It  is  obtained  by  distillation  with  water  vapor.  It 
is  insoluble  in  cold  water,  sparingly  soluble  in  boiling  water  and  in 
ether,  more  in  cold  alcohol,  easily  in  hot  alcohol,  and  in  chloroform. 
It  dissolves  readily  in  alkalies,  passing  into  anemonic  acid. 

Physiologic  Action. — Brunton  says  anemonin  may  cause  local 
inflammation  and  gangrene  when  given  subcutaneously,  vomiting 
and  purging  when  given  by  the  stomach.  It  depresses  the  circula- 
tion, respiration  and  spinal  cord,  somewhat  resembling  aconitine.  The 
symptoms  are  slow,  weak  pulse,  slow  respiration,  coldness,  paralysis 
beginning  with  the  legs  and  extending  to  the  arms,  dyspnea,  and 
death  without  convulsions.  Poisoning  by  pulsatilla  is  always  at- 
tended with  convulsions,  their  absence  being  due  to  the  paralysis 
by  anemonin  of  the  cerebral  motor  centers,  and  the  possible  presence 
in  the  herb  of  another  convulsant  principle. 

Van  Renterghem  found  that  it  required  doses  of  o.oi  every  hour 
for  fifteen  hours  to  produce  cognizable  effects.  These  were  light 
prodromes  of  dyspepsia,  anorexia,  the  sensation  of  a  foreign  body  in 
the  oesophagus  that  could  not  be  passed  on  to  the  stomach ;  all  dis- 
appearing by  the  following  morning.  The  stools  were  normal,  one 
or  two  daily,  the  subject  being  usually  constipated.  A  single  dose 
of  0.05  produced  similar  effects.  He  concludes  that  in  these  doses 
anemonin  is  not  irritant  to  the  stomach  or  bowels. 


18  ANEMONIN 

Ellingwood  states  that  pulsatilla  in  toxic  doses  produces  mental 
hebetude,  dilated  pupils',  coma ;  it  lowers  the  pulse,  vascular  tension 
and  heart-force,  and  causes  convulsions.  It  depresses  sensation  and 
motion.  In  small  doses  it  stimulates  the  cerebral  functions  and 
tones  the  sympathetic,  increases  cardiac  power,  slowing  the  rapid 
weak  pulse  of  nervous1  prostration. 

Therapeutics. — Anemonin  has  been  given  in  amenorrhea,  dys- 
menorrhea,  bronchitis,  and  other  catarrhs,  and  in  asthma  (Brunton). 

Borchain  recommends  it  in  acute  epididymitis.  Shapter  found 
it  useful  in  hysteric  convulsions,  and  in  reflex  uterine  spasms. 

Phillips  speaks  of  it  as  useful  in  mental  disorders,  and  in  sud- 
den suppression  of  the  menstrual  or  the  lochial  flow. 

Bovet  considers  it  a  decided  sedative  in  dysmenorrhea.   v 

Ellingwood  gives  as  specific  indications  for  this  agent,  amenor- 
rhea with  mental  perturbation  and  apprehension;  spermatorrhea 
with  fear;  when  genital  maladies  cause  great  anxiety.  The  homeo- 
pathists  appear  to  give  it  whenever  the  patient  is  in  apprehension 
of  coming  disaster.  Anemonin  gives  strength  and  tone  to  the  repro- 
ductive organs,  regulating  their  actions,  in  the  absence  of  acute 
hyperemia  or  inflammation.  When  this  mental  state  is  present  dur- 
ing pregnancy,  with  general  lack  of  tone,  anemonin  is  beneficial; 
also  in  nervous  exhaustion,  nervous  headache;  the  constipation, 
enuresis  and  dysuria  of  hysteria  and  pregnancy;  urinary  irregular- 
ities of  pregnancy  with  ammoniacal  urine,  pain,  tenesmus,  catarrh, 
burning  or  shooting  pains ;  in  leucorrhea  with  pain  in  the  loins,  de- 
bility, depression,  anorexia  and  general  nervousness ;  in  eruptive 
fevers,  especially  measles  with  excessive  mucous  irritation. 

Scudder  gives  as  specific  indications  for  this  remedy:  Patient 
nervous  and  depressed,  cries  easily,  pulse  small  and  frequent,  but 
soft ;  extremities  cold ;  menses  tardy  and  scant ;  patient  then  uneasy 
and  depressed,  with  fullness  and  weakness  in  hips  and  back.  It 
stimulates  the  mind  and  automatic  ganglia.  Heart  symptoms  due  to 
apprehension  give  way  to  pulsatilla.  It  relieves  the  nervous  symp- 
toms of  the  menopause,  especially  with  feeble  nutrition. 

Webster  credits  pulsatilla  with  a  favorable  influence  over  dis- 
eased synovial  membranes ;  in  crural  phlebitis,  varicocele,  ophthal- 
mia, earache  of  children  (applied  locally),  "black  eye,"  purpura, 
tinnitus  aurium. 

Merrell  adds  to  these  indications  that  of  gastric  distress  after 
rich,  greasy  food;  gastrointestinal  catarrhs,  wandering  rheumatic 
pains,  urticaria  and  styes. 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


APIOL.  19 

As  the  active  agents  in  pulsatilla  are  volatile,  it  is  not  surpris- 
ing that  preparations  made  from  the  dried  plant  should  have  proved 
"inert." 

Van  Renterghem  lists  the  following  affections  as  benefited  by 
anemonin :  Corneal  leucoma  and  albugo,  retinal  anesthesia,  com- 
mencing cataract,  amblyopia,  amaurosis,  especially  in  arthritics  or 
with  functional  abdominal  disorders,  where  anemonin  may  be  given 
alone  or  with  strychnine ;  commencing  atrophy  of  the  optic  nerve. 
In  these  ocular  affections  anemonin  may  be  used  locally  and  in- 
ternally. Paraplegias  relieved  by  anemonin  by  Seidler  and  others, 
were  probably  peripheric  and  diathetic.  Clarus  reported  good  re- 
sults in  bronchitis,  influenza  and  whooping-cough,  rebellious  and 
irritant  cough.  Storck  advised  it  to  allay  inveterate  rheumatismal 
pains ;  and  Von  Schroff  in  chronic  exanthems,  serpiginous  and 
syphilitic  ulcers,  found  it  useful. 

Merck  gives  the  dose  of  anemonin  as  0.015 — 0.05  (gr.  }4  to  24  )> 
twice  daily;  maximum  daily  dose  0.2  (gr.  3). 

Van  Renterghem  advised  doses  of  o.ooi — o.oi  every  hour. 


APIOL. 

Standard  granule — Apiol,  true,  gr.  1-67,  gm.  .001. 

The  interest  in  apiol  dates  from  the  appearance  of  Bartholow's 
book,  in  which  he  stated  that  this  substance  was*  an  effective  em- 
tnenagog,  which  was  also  safe  in  case  of  pregnancy,  as  it  did  not 
cause  abortion.  It  is  a  remarkable  thing,  that  apiol  should  discrim- 
inate between  the  pregnant  and  the  non-pregnant  female,  and  give 
the  latter  needed  and  desirable  relief,  while  with  adamantine  virtue 
it  resisted  the  beseechings  of  the  unwise  damsel  and  refused  the 
still  more  ardently  desired  comfort. 

Is  it  true?  For  my  part  I  confess  that  I  have  never  tried  it.  In 
these  days  the  evidences  of  pregnancy  are  so  complete,  so  easy  to 
elicit,  that  there  is  no  excuse  for  a  mistake  in  diagnosis — at  least  in 
all  the  cases  that  have  come  under  my  care  it  was  possible.  And  if 
circumstances  arise  that  render  the  diagnosis  uncertain,  there  is  al- 
ways the  resource  of  delay  till  time  settles  this  question. 

And  this  seems  to  be  the  position  occupied  by  the  profession,  for 
in  all  the  years  since  Bartholow  wrote  I  have  never  seen  any  report 
on  this  interesting  question,  and  I  am  still  at  a  loss  as  to  its  solution. 

This  is  the  result  of  an  extended    quest    through    the    medical 


20  APIOL. 

literature  on  the  subject  of  apiol,  the  results  of  which  are  herewith 
presented. 

There  i&,  however,  without  question  a  very  general  belief  among 
practicians,  that  any  active  preparation  containing  apiol  is  really 
a  dependable  remedy  in  amenorrhea.  The  marked  success  of 
several  proprietary  articles  of  this  nature  must  be  due  to  effects 
obtained  from  this  agent.  And  clinical  experience  has  proved  that 
apiol  has  marked  emmenagog  effects.  The  effective  dose  is  very 
large,  but  even  when  given  during  early  pregnancy,  either  by  error 
of  diagnosis  or  with  criminal  intent,  apiol  has  failed  entirely,  I 
have  been  informed,  in  emptying  the  uterus  of  its  undesirable  con- 
tents. In  all  cases  of  menstrual  suppression  not  due  to  pregnancy, 
apiol  alone  or  combined  with  aloin  and  savine,  has  proved  decidedly 
effective. 

Green  apiol  is  an  oily  liquid  obtained  from  the  garden  parsley, 
Petroselinum  sativum,  the  yield  varying  from  I  to  3  per  cent.  It  is 
also  found  in  celery  and  in  Apium  graveolens.  It  is  soluble  in  al- 
cohol and  ether;  is  of  a  strong  odor  and  sharp,  disagreeable  taste. 

White  apiol  or  "parsley  camphor"  is  a  stearoptene,  soluble  in 
alcohol,  ether  and  oils.  It  occurs  in  long  needle  crystals  of  a  faint 
parsley  odor.  It  has  been  given  in  malaria  and  amenorrhea. 

Physiologic  Action. — In  doses  of  gr.  7*4  to  15  green  apiol  pro- 
duces sensations  similar  to  those  of  coffee;  a  sense  of  strength 
and  euphoria,  and  warmth  in  the  stomach.  Doses  of  gr.  30  to  60 
cause  toxic  symptoms,  fever,  headache,  digestive  disturbances, 
vertigo,  ringing  in  the  ears,  deafness,  scintillations,  heavy  frontal 
aching,  the  symptoms  resembling  those  of  overdoses  of  quinine. 
Apiol  is  strongly  diuretic.  In  doses  of  gr.  9  to  12  it  causes 
dicrotic  pulse  and  disorders  the  rhythm  of  the  heart. 

Merck  gives  the  dose  of  his  product  as  m.  5  to  10  of  the  green,  or 
for  malaria -m.  15  to  30;  while  the  dose  of  the  white  is  gr.  5  three 
times  a  day,  or  up  to  a  dram  daily  as  a  maximum. 

Shoemaker  says  parsley  is  carminative,  diuretic,  emmenagog, 
slightly  laxative,  stimulating  the  skin,  circulation  and  bronchial 
mucous  membrane.  It  contains  apiolin,  apiin  and  cariol. 

Cariol  causes  genital  hyperemia,  increases  the  urine,  general 
tremors  or  slight  convulsions,  paresis  or  motor  incoordination,  and 
finally  death  by  asphyxia.  In  experiments  on  animals  the  dorso- 
lumbar  cord  was  much  congested,  and  the  uterine  vessels  engorged. 

Apiol  acts  like  cariol  on  the  nervous  and  circulatory  systems, 
causing  a  rapid  rise  of  arterial  pressure,  due  to  increase  of  the  heart- 


APIOL.  21 

action  and  stimulation  of  the  vasomotor  centers  in  the  medulla. 
Both  increase  the  muscular  excitability.  Apiol  congests  the  uterus 
and  ovaries,  and  increases  the  mucous  flow.  Both  are  useful  in 
spinal  atony. 

Apiolin  in  toxic  doses  causes  somnolence,  stupor,  paresis,  motor 
incoodination,  increased  respiration  and  circulation,  and  death  by 
asphyxia.  Small  doses  act  on  the  unstriped  muscular  fiber,'  espe- 
cially of  the  uterus,  in  pigs  causing  abortion. 

Therapeutics. — Apiol  has  been  used  as  a  diuretic  in  dropsies, 
strangury  and  gonorrhea.  It  is  not  equal  to  quinine  in  agues.  It  is 
used  for  amenorrhea  and  dys'menorrhea.  It  is  best  suited  for  the 
amenorrhea  of  anemia;  and  if  this  is  marked,  iron  may  be  added 
with  advantage. 

King  recommends  apiol  in  scarlatinal  dropsy,  retention  of  urine 
and  as  a  local  application  for  the  stings  and  bites  of  insects,  bruises, 
enlarged  glands  and  swollen  breasts.  It  dries  up  the  milk.  He  also 
recommends  it  for  fetid  menstruation,  neuralgic  dysmenorrhea  ami 
uterine  colic,  and  for  the  night-sweats  of  phthisis. 

Homolle  and  Joret  gave  apiol  in  43  cases  of  ague,  curing  21  cases 
with  one  dose,  n  with  two  doses,  4  with  three,  I  with  seven,  and 
failing  in  six  cases.  Homolle  also  found  apiol  useful  in  neuralgias, 
dysmenorrhea  and  amenorrhea. 

The  apiol  of  commerce  is  a  mixture  of  the  active  principles,  of 
which  apiolin  is  perhaps  the  most  effective.  This  comes  to  us  from 
France  elegantly  prepared  in  capsules. 

I  have  given  apiol  and  apiolin  for  amenorrhea  and  found  it  ef- 
fective. In  fact,  I  look  upon  it  as  one  of  the  most  satisfactory  em- 
menagogs  in  use,  and  one  singularly  free  from  unpleasant  or  objec- 
tionable qualities.  Neither  distress  nor  hemorrhage  has  ever  fol- 
lowed its  administration  in  my  hands.  I  doubt  the  limitation  to 
anemic  cases,  and  several  times  have  prescribed  it  for  fat,  plethoric 
women,  who  had  every  month  great  difficulty  in  getting  the  flow 
started,  and  without  help  would  have  none,  but  very  marked  fullness 
in  the  head,  and  headache,  tinnitus,  etc.  In  every  case  of  this  de- 
scription apiol,  in  doses  of  five  minims  three  times  a  day,  in  capsules, 
succeeded  in  inducing  the  flow  within  three  days,  when  given  at  the 
menstrual  period.  In  one  case  of  this  character  apiol  succeeded  after 
the  strongly  purgative  emmenagog  tablets  had  failed  though  purg- 
ing to  the  production  of  hemorrhoids. 

In  the  anemic  cases  for  which  apiol  is  recommended  by  some 
authorities,  it  is  not  wise  to  give  anything  to  incite  the  flow,  until 


22  APOCYNIN 

by  the  use  of  iron,  and  proper  hygiene,  and  laxatives  usually,  the 
patient  has  been  raised  to  such  affluence  of  blood  as  to  enable  her  to 
spare  what  is  required  for  the  monthly  loss.  Sometimes  amenorrhea 
is  a  warning  from  the  body  that  the  expenditure  is  not  warranted ; 
though  women  usually  look  upon  the  cessation  of  the  flow  as  the 
cause  of  the  ailments  that  really  are  the  reasons  for  the  discontinu- 
ance.' The  physician  should  take  time  to  patiently  explain  this,  as 
serious  harm  may  result  from  unwise  efforts  to  compel  the  flow  from 
an  exhausted  body. 

APOCYNIN. 

Standard  granule — Gr.  1-12,  gm.  .005. 

Apocynin  is  the  active  principle  of  the  American  hemp,  Apocy- 
num  cannabinum.  From  another  of  the  Apocyneae,  Aescanthera 
ouabaio,  is  derived  ouabaine,  the  arrow  poison  of  the  Somalis. 
Apocynin  belongs  to  the  digitalis  group,  possessing  their  diuretic 
properties,  but  differs  somewhat  in  its  action  on  the  heart. 

This,  the  only  really  useful,  active  principle  of  Apocynum  can- 
nabinum (Nat.  Ord.  Apocynaceae)  is  obtained  from  the  root  of  the 
plant.  The  popular  names  of  Apocynum  are  Black  Indian  Hemp, 
and  Dogsbane.  Besides  apocynin,  a  glycoid,  apocynein,  soluble  in 
water,  has  been  extracted;  but  the  latter  is  little  used  therapeutically 
The  Eclectics  have  pushed  this  remedy  to  the  front  and  consider  it 
one  of  the  most  useful  drugs  in  their  list. 

Therapeutics. — The  information  we  can  glean  from  the  standard 
works  upon  therapeutics  of  apocynin  is  not  startling  in  its  richness. 

Shoemaker  says  apocynum  is  emeto-cathartic  from  its  apocynein, 
diuretic  from  its  apocynin.  The  former  is  soluble  in  water,  hence 
the  irritating  qualities  of  the  decoction.  Apocynin  is  soluble  in 
alcohol,  ether  and  chloroform,  but  not  in  water. 

Richmond  found  the  plant  useful  in  jaundice  and  as  an  expec- 
torant. Glinski  found  it  relieved  the  functional  disturbances  attend- 
ing organic  heart-disease  and  lessened  the  area  of  dullness  in 
cardiac  dilatation. 

Hare  advises  that  if  good  results  do  not  follow  the  use  of  the 
drug,  another  sample  should  be  tried;  but  if  you  ask  him  why  he 
doesn't  use  the  active  principle  and  avoid  such  uncertainty,  what 
will  he  say  ?  He  states  that  the  effects  of  apocynum  in  causing  pro- 
fuse diuresis,  in  cardiac  and  renal  dropsy,  have  won  for  this  drug 
the  name  of  the  "vegetable  trocar." 


APOCYNIN  23 

Murray  mentions  as  the  only  unpleasant  effect,  throbbing  of  the 
cerebral  vessels. 

We  turn  to  the  Eclectics  and  there  find  much  more  extended  and 
precise  data. 

King  says  full  doses  cause  vomiting,  purging,  sweating  and 
diuresis,  preceded  by  somnolence.  As  a  diaphoretic  it  is  of  value 
in  malarial  fevers  and  pneumonias. 

The  decoction  is  useful  in  irritation  and  congestion  of  the  uterus, 
with  nausea,  vomiting,  tympanites',  headache  and  aortic  pulsation. 
The  leading  indication  is  dropsy  with  debility  or  struma,  but  no  al- 
buminuria.  when  it  is  to  be  given  in  small  doses  to  remove  the 
oedema  but  not  as  a  purge.  It  acts  by  restoring  cardiac  force.  If 
the  dropsy  is  due  to  organic  disease  of  the  heart,  liver  or  kidneys, 
apocynin  will  not  relieve,  but  mitigates  the  affection.  Nor  is  it  in- 
dicated in  fever,  nor  when  the  pulse  is  full  and  hard.  Atony  is  the 
specific  indication,  with  escape  of  the  blood-serum  into  the  tissues, 
which  become  water-soaked.  Anemia  is  also  present.  It  has  been 
used  with  benefit  in  acute  and  chronic  hydrocephalus,  malarial  and 
scarlatinal  dropsies. 

Another  action  of  importance  is  in  amenorrhea,  passive  menor- 
rhagia,  and  leucorrhea,  the  uterus  large  and  flabby,  its  tone  relaxed. 
CEdema  may  coexist  elsewhere. 

In  young  girls  where  the  menstrual  flow  is  too  free,  comes-  too 
often  and  lasts  too  long,  apocynum  is  effective.  Old  scrofulous  and 
syphilitic  cases  are  benefited,  which  indicates  a  depurative  action. 
In  atonic  dyspepsias  it  removes  constipation  and  fluid  accumulations. 
Rheumatism  is  benefited  by  apocynum  only  if  oedema  is  present  or 
the  parts  are  puffy  or  glistening. 

As  a  heart-tonic,  it  is  useful  in  dilation  of  the  ventricles  but  not 
when  the  pulse  is  hard  or  quick. 

One  case  was  reported  in  which  apocynum  benefited  an  angina 
with  oedema.  The  precordial  oppression  caused  by  tobacco  was  also 
relieved  by  this  drug.  It  is  most  valuable  in  renal  congestion,  the 
second  stage  of  desquamative  nephritis.  Goss  affirmed  that  it  was 
a  remedy  for  ascarides. 

Webster  says  that  it  is  a  specific  for  oft-recurring  catarrhal  at- 
tacks limited  to  the  larynx,  pharynx  and  post-nasal  region.  He 
speaks  also  of  its  use  in  cases  of  agonizing  pain  in  the  hip  or  groin, 
attributed  to  sciatica,  where  it  gave  prompt  relief  when  morphine 
failed.  The  same  writer  values  it  in  the  dyspepsias  of  diabetes 
insipidus. 


24  APOMORPHINE 

Ellingwood  says  apocynum  increases  the  nervous  force  and  the 
respiration,  as  well  as  the  oxidation  of  the  blood.  It  causes  diuresis 
even  when  the  heart  is  not  affected.  It  does  not  irritate  the  kidneys, 
but  overdoses  have  occasioned  suppression  of  urine — probably  by 
shutting  off  the  renal  arteries.  It  is  of  use  in  acute  nephritis  but  the 
inflammation  calls  for  other  remedies'  to  be  added.  He  adds  iron 
for  anemics.  Apocynin  controls  passive  hemorrhages. 

The  desirable  effects  of  the  American  hemp  are  due  to  the  neutral 
principle  apocynin,  and  a  distinct  gain  is  obtained  by  excluding  the 
irritant  emeto-cathartic  apocynein.  The  former  has  proved  a  highly 
reliable  diuretic  and  heart-tonic,  closely  resembling  digitalin  in  these 
respects,  but  differing  in  that  the  hemp  derivative  acts  on  the  liver 
also,  and  increases  the  solid  output  from  thi&  organ  and  the  kidneys. 

The  limitation  of  its  use  to  cases  with  low  vascular  tension  should 
be  heeded.  The  best  dosage  appears  to  be  gr.  1-12  every  two  hours 
except  when  asleep,  gradually  increased  to  four  times  this  dose,  or 
until  a  satisfactory  state  of  vascular  tension  has  been  secured.  The 
occurrence  of  nausea  or  purging  is  an  indication  to  moderate  the 
dose. 

Failure  will  surely  occur  if  the  drug  is  given  when  the  indications 
are  not  present ;  hence  apocynin  is  assuredly  not  "a  remedy  for 
dropsy*"  in  all  forms  and  conditions. 

APOMORPHINE. 

Standard  granule — Gr.   1-67,  gm.  .001. 

Apomorphine  is  a  white  powder  obtained  by  heating  morphine 
and  concentrated  hydrochloric  acid  at  301°  F.  One  molecule  of  wa- 
ter is  lost.  Exposed  to  air  or  in  water  apomorphine  becomes  apple- 
green,  without,  however,  affecting  its  physiologic  action.  This  dif- 
fers from  that  of  morphine  mainly  in  the  loss  of  the  'latter's 
depressant  effects,  and  the  concentration  of  the  stimulant  action  on 
the  vomiting  center.  It  is  not  excreted  into  the  stomach  like  mor- 
phine, and  may  be  decomposed  in  the  body. 

Physiologic  Action. — Given  hypodermically,  in  doses  of  0.006 
(gr.  i-io),  apomorphine  causes  vomiting  within  ten  minutes,  the 
nausea  quickly  ceasing  unless  larger  doses  have  been  given.  It  also 
stimulates  the  secretion  of  saliva,  respiratory  mucus,  tears,  and 
sweat.  Pulse  and  respiration  become  rapid,  and  the  patient  com- 
plains of  depression  and  debility.  If  larger  doses  than  necessary  are 
given,  the  symptoms  reach  the  degree  of  collapse,  especially  in  chil- 
dren. 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


APOMORPHINE  25 

If  given  by  the  mouth  in  similar  doses,  according  to  Murrell, 
apomorphine  does  not  even  cause  nausea,  but  powerfully  stimulates 
the  secretion  of  the  respiratory  mucous  membrane.  Rossbach  states 
that  non-emetic  doses  promote  the  excretion  of  mucus  and  make  it 
more  fluid.  Cushny  claims  that  this  is  simply  the  beginning  of  the 
action  that  leads  to  vomiting. 

Vomiting  is  due  to  the  action  of  the  drug  on  the  medullary 
center,  not  to  gastric  irritation.  If  apomorphine  be  directly  applied 
to  the  medulla,  vomiting  occurs  at  once.  Batelli  found  the  stomach 
passive  during  vomiting  from  apomorphine.  Schultz  found  it  un- 
dergoing peristalsis  towards  the  cardiac  orifice. 

Locally,  apomorphine  solution  anesthetizes  the  cornea,  causing 
dimness  of  vision.  As  with  morphine,  a  feeling  of  well-being—- 
euphoria— lassitude  or  somnolence,  may  follow  the  primary  effect  of 
apomorphine,  whether  emetic  or  expectorant. 

Toxic  doses  paralyze  the  emetic  center  and  narcosis  ensues,  with 
abolition  of  reflexes  and  dilatation  of  the  pupil. 

The  centers  of  voluntary  motion  are  excited  strongly,  then  de- 
pressed. The  respiratory  centers  are  violently  agitated  but  not  de- 
pressed subsequently.  The  emetic  center  is  excited  by  small  doses, 
depressed  by  larger  ones.  The  peripheral  nerves,  motor  and  sensory, 
are  not  depressed.  The  cardiac  accelerator  nerves  are  excited,  the 
blood-pressure  being  unaffected.  It  is  uncertain  if  the  striated  and 
cardiac  muscular  fibers  are  depressed  in  man  as  they  are  in  the  frog. 
The  temperature  falls. 

Liebreich  says  apomorphine  has  no  influence  on  the  striated 
muscles,  the  motor,  sensory  or  vasomotor  nerves  of  mammals. 
Reichert,  however,  showed  that  toxic  doses  lower  arterial  pressure, 
following  a  distinct  rise,  which  is  prevented  by  previous  section  of 
the  cord,  and  is  therefore  due  to  stimulation  of  the  vasomotor 
centers.  He  also  showed  that  apomorphine  is  a  muscle-poison 
(Wood).  Reichert's  observations  apply  to  toxic  doses. 

Apomorphine  hydrochlorate  forms  small,  white  or  grayish 
crystals,  soluble  in  6  to  8  parts  of  water,  or  fifty  of  alcohol,  but  not  in 
ether  or  chloroform.  Treated  with  nitric  acid  it  forms  a  blood-red 
solution  ;  with  an  excess  of  caustic  soda  a  purple  or  dark  solution. 
The  watery  solution  is  nearly  or  quite  colorless ;  becoming  emerald 
green  in  100  parts  of  water  it  is  to  be  rejected.  It  must  give  no  color 
to  ether.  When  released  by  soda  bicarbonate  apomorphine  decom- 
poses more  easily  than  the  chlorate,  and  is*  then  soluble  in  ether  or 
chloroform,  with  a  purplish-red  or  bluish-violet  coloring.  Hence 


26  APOMORPHINE. 

a  little  hydrochloric  acid  improves  the  keeping  quality  of  the  solu- 
tion. 

Therapeutics. — As  the  only  emetic  for  hypodermic  use,  apo- 
morphine  is  of  value  in  cases  where  quick,  safe  and  sure  emesis 
is  necessary,  with  the  minimum  of  nausea;  as  in  treating  unruly 
lunatics',  drowning  persons,  those  who  have  swallowed  poison,  as 
well  as  in  croup,  bronchopneumonia,  and  wherever  it  is  necessary 
to  free  the  pulmonary  tract  of  secretions. 

Liebreich  says  the  expectorant  effect  may  not  appear  for  two 
days. 

Vallender  found  it  useful  in  epilepsy. 

Sleep  has  followed  its  nauseant  action  in  the  insane. 

Apomorphine  has  also  been  given  largely  in  treating  the  alcohol 
habit,  but  the  effect  here  must  be  credited  to  suggestion,  as  an  effort 
is  always  made  to  have  the  patient  attribute  the  nausea  to  liquor.  If 
Murrell  is  correct,  it  is  useless  to  add  apomorphine  to  the  liquor 
drank,  as  it  will  not  nauseate.  Emetine,  lobelin  or  tartar  emetic 
would  be  preferable. 

In  narcosis,  even  if  the  patient  is  too  far  gone  for  swallowing, 
apomorphine  will  still  induce  emesis. 

Pecholier  took  hypodermically  0.015  (gr.  1-4)  for  angina,  pro- 
ducing unconsciousness  and  cessation  of  respiration,  recovering  un- 
der stimulants,  vomiting  occurring  after  reaction.  Large  doses 
given  to  children  caused  rocking  motion  of  the  head  and  arms, 
twitching,  chewing  and  hiccough. 

As  an  expectorant  apomorphine  stimulates  fluid  secretion  and 
liquefies  tough,  tenacious  mucus ;  hence  in  dry  catarrhs  it  is  of  use, 
and  might  be  so  in  membranous  croup  and  bronchitis  were  the 
effects  more  promptly  manifested  than  Liebreich  asserts.  If  Mur- 
rell's  explanation  is  correct,  the  secretion-stimulus  can  be  secured 
by  injecting  doses  too  small  to  cause  emesis. 

As  an  emetic  to  adults,  the  average  dose  is  0.007  (gr.  i-io)  but 
in  feeble  "collapsy"  subjects,  half  this  dose  is  advisable.  Murrell 
advises  even  larger  doses  by  the  stomach  as  an  expectorant,  but  it  is 
safer  to  adopt  the  "intensive"  method  of  dosage,  giving  o.ooi  (gr. 
1-67)  every  half  to  two  hours  till  effect.  The  depressant  effects  are 
combated  promptly  by  atropine.  When  administered  internally  apo- 
morphine should  be  given  in  granules,  or  in  simple  syrup  (with  hy- 
drochloric acid)  and  the  air  excluded,  when  deterioration  will  not 
occur  for  weeks.  Cushny,  however,  states  that  although  the  solu- 
tion changes  even  to  black,  its  activity  is  not  appreciably  impaired. 


'APOMORPHINE.  -27 

In  narcotic  poisoning1  the  depression  of  the  medullary  centers 
may  be  too  great  to  allow  the  action  of  apomorphine ;  when  the 
stomach  should  be  washed  out.  Or  if  the  patient  can  swallow,  a 
seidlitz  powder  should  be  given,  first  the  contents  of  the  blue  paper 
in  solution  being  swallowed,  and  then  the  contents  of  the  white 
paper,  also  in  solution.  Effervescence  occurs  in  the  stomach,  giving 
the  most  prompt  emetic  effect  producible,  without  the  slightest 
nausea  or  symptom  of  collapse. 

All  emetics  are  contraindicated  in  corrosive  or  irritant  poisoning, 
in  atheroma,  fatty  or  dilated  heart  or  aneurism,  where  a  sudden  rise 
of  blood-pressure  is  dangerous ;  also  in  advanced  pregnancy,  reduci- 
ble hernia,  gastric  or  intestinal  ulcer,  impacted  gall-stone,  abdominal 
abscess,  or  in  any  other  case  in  which  a  sudden  strain  may  do  harm. 

Apomorphine  in  emetic  doses,  hypodermically,  has  been  used 
with  success  to  break  up  paroxysmal  attacks  of  hysteria.  Ringer 
says  it  cured  a  case  of  hiccough  when  morphine  and  atropine  had 
failed.  Weill  and  Gee  found  it  useful  in  chorea. 

Murrell  believes  the  difference  in  the  effect  of  apomorphine  when 
.-idministered  hypodermically  or  otherwise  is  simply  due  to  the  rate 
of  absorption.  He  found  this  salt  could  be  applied  to  the  skin  as 
an  ointment,  in  doses  of  o.oi — 0.07  (gr.  1-6 — i),  well  rubbed  in, 
when  it  acted  as  an  expectorant,  inducing  no  nausea.  This  is  a 
valuable  method  in  treating  children. 

Brunton  advises  morphine  and  apomorphine  given  together  for 
cough,  to  increase  mucous  secretion  and  lessen  irritability  of  the 
respiratory  center ;  especially  when  there  is  dyspnea,  constant  cough 
and  tough  mucus. 

Murrell  advises  apomorphine  in  a  spray,  as  an  expectorant,  using 
half  a  dram  of  the  i-per-cent  solution,  if  needed.. 

Shoemaker  mentions'  the  use  of  apomorphine  as  a  remedy  for 
spasmodic  croup,  asthma,  convulsions,  strychnine  poisoning, 
maniacal  delirium,  and  to  relax  rigidity  of  the  os  uteri.  He  states 
that  this  drug  should  not  be  continued  too  long,  as  it  is  liable  to 
produce  pulmonary  oedema. 

The  dose  of  apomorphine  hydrochlorate  as  an  emetic  is  0.0x33 — 
0.006  (gr.  1-20 — i-io),  as  an  expectorant  o.ooi — 0.003  (gr.  1-67 — 
1-20),  according  to  Merck.  It  has  been  applied  in  skin  diseases  of 
infants  in  ointment  of  1-5  of  one  per  cent. 

Apomorphine  antidotes  strychnine,  chloral  and  chloroform,  be- 
ing a  physiologic  opponent  of  the  latter  two.  It  is  incompatible 
chemically  with  alkalies,  potassium  iodide,  and  iron  chloride. 


28  ARBUTIN 

In  giving  apomorphine  to  poisoned  patients  (children  especially) 
it  is  well  to  give  small  doses  of  strychnine  to  support  the  heart. 

It  should  be  remembered  that  given  per  rectum  apomorphine  is 
emetic  in  doses  of  from  1-6  to  1-2  gr.  There  are  times  when  this 
is  the  easiest  and  in  fact  the  only  way  to  give  this  drug :  the  patient 
cannot  swallow  and  the  attending  practician  may  be  far  from  his 
hypo,  needle.  If  then  he  will  empty  the  lower  bowel  and  throw  into 
it  one-half  grain  of  the  drug,  dissolved  in  an  ounce  of  hot  water,  the 
characteristic  effects  will  follow  in  less  than  ten  minutes. 


ARBUTIN. 

Standard  granules — Gr.  1-6,  gm.  .01 ;  gr.  1-67,  gm.  .opi. 

Arbutin  is  a  glucoside  obtained  from  uva  ursi,  Gaultheria  pro- 
cumbens,  pipsissewa,  and  other  species  of  Arbutus.  It '  occurs  in 
silky,  needle-like  crystals,  soluble  in  boi  ling  water  and  in  alcohol, 
slightly  in  cold  water.  It  is  bitter,  and  the  solution  does  not  ferment 
with  yeast.  With  iron  chloride  it  gives  a  blue  color.  It  is  mostly 
excreted  unchanged  in  the  urine  in  a  short  time,  a  little  being  ex- 
creted in  the  urine  as  hydrochinone  sulphuric  acid.  Lewin  thinks 
the  formation  of  hydrochinone  may  cause  therapeutic  effects  in  the 
urinary  tract.  Mencke  hoped  that  arbutin  might  cure  gonorrhea 
through  the  formation  of  free  hydrochinone,  but  this  was  disproved 
by  Paschkis. 

Arbutin  is  undoubtedly  the  principle  to  which  these  plants  owe 
chiefly  their  activity.  It  is>  stimulating  to  the  renal  cells,  and  mildly 
antiseptic.  In  large  doses  uva  ursi  causes  vomiting  and  diarrhea, 
but  arbutin  does  not  have  this  effect.  The  leaves  of  uva  ursi  contain 
3.5  per  cent  of  arbutin  and  34  per  cent  of  tannic  acid.  Thus,  in 
using  the  leaves  to  obtain  15  grains  of  arbutin,  a  full  dose,  one  must 
take  about  150  grains  of  tannic  acid,  besides  enough  woody  fiber 
and  other  useless'  matter  to  make  the  dose  up  to  an  ounce. 

Physiologic  Action. — Brunton  ranks  arbutin  among  the  astrin- 
gents, coagulating  albumin  and  constringing  the  cells,  not  the  blood- 
vessels. It  diminishes  the  exudation  of  albumin  through  the  Mal- 
pighian  tufts,  more  powerfully  than  tannic  acid.  Its  specific  value  is 
in  catarrhs  of  the  bladder  and  the  genitourinary  passages. 

Hughes  found  arbutin  a  powerful  diuretic  in  doses  of  one  grain. 
It  is  not  toxic,  as  Jablonowski  took  within  forty-eight  hours  20 
grams  of  it  without  discomfort.  Though  Brunton  has  shown  that 


ARBUTIN  29 

arbutin  is  more  powerful  than  tannic  acid,  Wood  still  asserts  that 
the  latter  supplies  the  chief  value  to  uva  ursi. 

Hydrochinone  causes  vertigo,  ringing  in  the  ears,  the  pulse  soft 
and  slow,  according  to  Brieger.  Martin  found  that  in  small  doses 
it  increased  vasomotor  tension,  which  large  doses,  however,  relaxed ; 
lowering  body  temperature  by  increasing  heat-radiation,  a  result  of 
vasomotor  paralysis.  Two  per  cent  added  to  fresh  urine  prevents 
alkaline  fermentation  for  many  days.  If  present  in  large  amount  it 
renders  the  urine  olive  green,  changing  to  dark  green  or  black. 

Therapeutics. — The  specific  indication  for  arbutin  is  atony  or 
hypersecretion  of  the  uropoietic  mucosa.  Introduced  subcutaneously 
or  by  the  mouth,  arbutin  is  eliminated  by  the  kidneys.  It  com- 
bats putridity  and  sepsis,  acting  alike  on  the  tissues  of  mucous 
cavities  and  the  urine  contained.  In  acute  or  chronic  cystitis, 
pyelitis,  pyelo-nephritis,  gonorrhea  and  leucorrhea  it  is  useful.  It 
corrects  putrid  fermentation  of  the  urine  with  ammoniacal  odor. 

Ungar  reported  the  case  of  a  man,  68,  with  hypertrophied 
prostate,  compelled  to  use  the  catheter  since  1875,  occasioning  an 
obstinate  cystitis.  Urination  was  almost  constant,  the  urine  fetid 
and  ammoniacal,  in  spite  of  intravesical  washings  with  carbolic 
solutions  one-half  per  cent,  twice  a  day,  with  salicylic  acid  by  the 
mouth.  In  1879  grave  hematuria  appeared,  repeated  until  1883  at 
least  weekly,  lasting  several  days  each  time.  Near  the  end  of  1884 
all  other  medication  was  discontinued  and  arbutin  alone  given  for 
four  days,  in  doses  of  0.5,  t.  i.  d.,  then  i.o  t.  i.  d.,  for  three  doses. 
The  effect  was  very  good.  For  some  weeks  the  urine  was  free  from 
pus  and  mucus,  the  bad  odor  disappeared,  the  hemorrhage  ceased, 
the  general  health  improved  and  the  continual  tenesmus  subsided. 
Had  not  the  continued  use  of  the  catheter  reproduced  the  malady  a 
complete  cure  would  have  been  obtained.  The  patient,  taking  still 
two  daily  doses  of  0.5  each,  has  not  presented  any  therapeutic  ac- 
cident whatever. 

Gris  cites  a  case  of  pyelitis  cured  by  Guyon  by  means  of  arbutin, 
and  says  he  could  cite  other  cases. 

Viriate  Brandao  reported  three  cases  of  cystitis  cured  by  arbutin, 
and  declared  that  its  use  superseded  the  need  of  other  remedies, 
sandal,  balsam,  etc.  Hughes  and  Menches  also  made  favorable  re- 
ports on  this  remedy  in  cystitis. 

Ferran  lauds  arbutin  in  his  work  on  the  maladies  of  old  age. 

While  large  doses  are  not  toxic,  they  are  largely  wasted ;  as  but 
a  small  quantity  is  decomposed  into  hydrochinone.  The  doses  should 


30  ARBUTIN 

i 

be  repeated  often — every  hour  or  two — on  account  of  the  rapidity  of 
elimination. 

Houde  recommends  0.04 — 0.08  every  hour  by  day,  and  each  time 
the  patient  rises  at  night  to  urinate.  The  daily  dose  should  be  from 
0.6  to  1.2;  or  enough  to  stop  urinary  putridity. 

Van  Renterghem  took  in  one  day  a  gram  of  Merck's  crystallized 
arbutin  without  experiencing  any  notable  effects  (in  health).  He 
recommends  the  administration  of  this  agent  every  half-hour,  to  in- 
sure its  continuous,  uninterrupted  influence ;  in  doses  of  o.oi — 0.02. 
He  reports  the  case  of  a  girl,  aged  22,  ill  six  months,  menses  stopped 
during  this  time,  with  grave  vaginal  blenorrhea  and  subacute 
vesical  catarrh ;  excessive  tenderness  to  examination,  vagina  dry, 
very  hot,  secreting  fetid  muGO-pus;  micturition  constant,  mucus 
fetid ;  sleepless,  no  iever,  appetite  and  digestion  good,  stools  twice 
a  week,  no  syphilis. 

Treatment,  (i)  The  vagina  was  irrigated  every  three  hours 
with  warm  borated  chloral  solution,  chloral  i.o,  borax  0.5,  water 
1000.  (2)  Enema  daily  of  magnesium  sulphate  solution.  (3)  Hy- 
oscyamine,  a  granule  every  fifteen  minutes  till  effect,  to  relieve 
vesical  tenesmus.  (4)  Arbutin  0.04,  digitalin  o.ooi,  every  hour 
from  6  a.  m.  to  10  p.  m. 

Reported  in  one  week.  Since  the  second  day  could  sleep  all 
night,  waking  only  two  or  three  times  to  urinate;  less  frequent 
urination  by  day ;  the  need  of  hyoscyamine  subsided  after  the  second 
day.  She  can  now  sit  down.  Genital  pains  and  discharge  subsid- 
ing, urine  more  limpid ;  on  the  road  to  recovery.  A  week  later  she 
reported  the  cure  almost  completed ;  she  was  attending  to  her  house- 
work. At  her  third  visit  the  cure  was  found  to  be  complete,  and  no 
relapse  occurred. 

Among  the  affections  for  which  the  arbutin-bearing  plants  have 
been  recommended  are  lithemia,  gout,  rheumatism,  dyspepsia, 
nephritis,  hematuria,  scrofula,  skin  diseases,  gleet,  leucorrhea  and 
ague ;  as  a  diuretic  in  dropsy ;  in  menorrhagia,  chronic  dysentery, 
bronchorrhea,  diabetes,  as  a  substitute  for  ergot  to  cause  uterine  con- 
tractions ;  and  in  enuresis. 

It  is  obvious  that  the  substitution  of  arbutin  for  the  plants  con- 
taining it  opens  up  a  new  era  in  the  treatment  of  genitourinary 
catarrhs.  The  enormous  quantity  of  tannic  acid  and  of  woody  con- 
stituents necessarily  taken  with  the  ordinary  preparations  of  these 
plants,  disguised  the  effects  of  arbutin,  caused  gastric  and  intestinal 
distress,  and  sadly  interfered  with  the  absorption  of  the  arbutin. 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


ARBUTIN  31 

Besides,  very  little  of  this  agent  is  present  in  watery  preparations, 
unless  taken  quite  hot.  For  these  reasons  uva  ursi  and  its  congeners, 
while  acknowledged  to  possess  a  specific  beneficial  action  upon  catar- 
rhal  affections  of  the  urinary  passages,  were  rated  as  uncertain, 
feeble  and  ineffective  remedies,  and  were  prescribed  as  adjuvants  or 
placeboes,  with  little  expectation  of  benefit.  Under  the  circum- 
stances it  seems  surprising  that  they  were  retained  in  the  official 
pharmacopeias — possibly  the  lack  of  anything  better  explains  their 
retention. 

But  with  the  production  of  arbutin  in  a  state  of  purity  all  this  is 
changed.  We  have  here  an  agent  of  unquestionable  and  remarkable 
power,  with  properties  sharply  differentiated  from  the  tannin  group 
of  astringents.  Indeed,  to  one  who  is  familiar  with  the  properties 
of  arbutin.  Wood's  assumption  that  it  is  the  tannic  acid  group  to 
which  uva  ursi  owes  its  effects,  can  only  provoke  a  smile. 

Arbutin  is  a  tonic  to  the  urinary  mucosa,  correcting  relaxation, 
checking  the  discharge  alike  of  albumin,  pus,  blood  and  mucus ;  and 
tending  to  restore  the  mucous  membrane  to  a  normal  state.  It  is 
alike  beneficial  in  gonorrheal  and  other  catarrhs.  It  subdues  irrita- 
bility and  soothes  the  excited  viscus,  relieving  vesical  tenesmus  or 
strangury,  not  as  hyoscyamine  does  by  lessening  nervous  hyper- 
esthesia,  but  by  lessening  the  congestion  and  driving  out  the  surplus 
blood.  Its  action  is  therefore,  more  slowly  manifested  but  more  en- 
during than  that  of  hyoscyamine. 

Arbutin  has  proved  alike  beneficial  in  acute  and  chronic  urinary 
catarrhs.  It  is  of  especial  benefit  when  the  urine  is  fetid  and  am- 
moniacal.  In  the  vesical  ailments  of  old  men,  with  dribbling,  fre- 
quent micturition,  the  calls  to  urinate  being  so  imperative  that  the 
victim  cannot  get  to  the  closet  quick  enough,  but  soils  his  clothes, 
arbutin  is  a  remedy  whose  value  will  be  manifested  whenever  it  is 
used. 

Secondarily,  it  is  beneficial  in  atonic  dyspepsia,  which  so  fre- 
quently accompanies  the  urinary  maladies  of  old  men.  This  com- 
bination of  properties  places  arbutin  in  the  very  front  rank  of  rem- 
edies for  this  class  of  ailments,  with  no  rival.  It  may  be  trusted 
implicitly — it  has  no  bad  after-effects  of  any  description,  no  dangers 
lying  in  wait  for  over-doses. 

In  acute  affections,  in  catheter  cystitis,  with  fetid  ammoniacal 
urine,  it  should  be  given  in  full  dosage,  up  to  a  gram  or  more  daily. 
In  all  cases  Van  Renterghem's  advice  should  be  followed,  and  the 
doses  given  every  half-hour  to  insure  a  continuous  action.  In 


32  ARECOLINE 

chronic  cases  it  may  be  given  in  increasing  doses,  beginning  with 
o.oi  every  half  to  one  hour,  and  increasing  until  the  urine  is  free 
from  turbidity  or  blood,  and  then  in  sufficient  doses  to  keep  it  clear. 

The  darkening  of  the  urine  from  arbutin  must  not  be  mistaken 
for  that  caused  by  overdoses  of  carbolic  compounds  like  salol.  The 
latter  breaks  up  the  red  blood  corpuscles,  causing  hemoglobinuria,  a 
dangerous  toxic  symptom ;  while  the  dark  color  of  the  urine  from 
arbutin  is  due  to  hydrochinone  and  is  not  a  toxic  symptom.  For  this 
reason  salol  and  arbutin,  both  useful  in  cystitis,  should  not  be  given 
together. 

In  very  old  and  persistent  catarrhs  it  has  been  found  of  benefit 
to  alternate  barosmin  and  arbutin  and  if  it  is  given  in  alternation 
with  benzoic  acid  in  those  cases  where  the  urine  is  excessively  am- 
moniacal  the  results  are  phenomenal.  It  will  readily  occur  to  the 
therapeutist  that  the  reputation  uva  ursi  has  gained  in  conditions  of 
excessive  mucous  discharges  in  the  urine,  is  due  to  the  presence  of 
arbutin  with  a  large  amount  of  tannic  acid  ;  hence  in  some  conditions 
it  is  advisable  to  give  arbutin  and  tannic  acid  togethei  or  alternately. 

ARECOLINE. 

Standard  granule — Gr.  1-134,  gm.  .0005. 

All  over  the  world  in  the  highest  grades  of  civilization  and  in 
the  lowest  savages,  we  find  an  almost  universal  tendency  to  indul- 
gence in  the  habitual  use  of  drugs,  for  the  pleasure  derivable  there- 
from apart  from  the  relief  of  disease.  Few  families  of  the  human 
race  are  without  some  form  of  alcoholic  intoxicant.  Tobacco  had 
only  to  be  introduced  for  the  craving  for  it  to  arise.  It  is  said  that 
the  Hottentots  of  Cape  Colony  sacrificed  for  tobacco  the  herds  which 
alone  afforded  them  security  against  starvation.  Every  plant  in 
which  caffeine  has  been  found  has  been  adopted  as*  the  basis  of  hot 
beverages,  tea  by  the  Chinese,  coffee  by  the  Arabs,  chocolate  by  the 
Mexicans,  guarana  by  the  Brazilian  Indians  and  mate  by  the 
Paraguayans.  Opium,  coca  and  hashish  spread  their  baleful  influ- 
ence in  spite  of  every  consideration  against  them ;  while  the  newer 
creations  of  the  chemist's  art  serve  as  the  basis  of  new  and  dis- 
astrous habituations. 

In  Eastern  Asia  immense  quantities  of  the  areca  nut  are  con- 
sumed, as  a  masticatory  mixed  with  the  leaves  of  the  Piper  betel. 
This  is  powerfully  astringent,  and  the  weak  conclusion  has  been  as- 
sumed, that  the  use  of  this  substance  is  occasioned  by  the  tendency 


ARECOLINE  33 

to  diarrhea  common  in  hot  latitudes.  No  evidence  is  offered  that 
the  chewing  is  especially  common  to  those  so  affected  or  that  it  is 
in  anyway  a  preventive,  or  is  so  considered ;  and  as  with  other  habit- 
drug^  we  must  until  better  data  are  obtainable  be  content  with  the 
explanation  that  men  chew  betel  because  they  like  to. 

The  betel  nut  is  obtained  from  the  Areca  catechu,  an  East  Indian 
palm.  Jahns  found  in  it  three  alkaloids,  arecaine,  arecoline  and 
traces  of  a  third,  probably  guvacine. 

Arecaine  occurs  in  stable  colorless  crystals,  very  soluble  in  water, 
in  diluted  alcohol,  less  in  absolute  alcohol,  insoluble  in  ether,  chloro- 
form or  benzine.  It  forms  soluble  salts-  and  has  an  acid  reaction. 
(Bocquillon  Limousin.) 

Jahns  considers  arecaine  the  active  principle  of  areca,  and  pro- 
nounces it  a  powerful  tenicide,  resembling  pelletierine.  Half  a  grain 
kills  a  rabbit  in  a  few  moments.  It  resembles  muscarine  but  de- 
presses both  respiration  and  heart,  causes  tetanic  convulsions  and 
increases  peristalsis  extraordinarily.  Locally  or  internally  used,  it 
contracts  the  pupils.  Dose  o.ooi  (Bocquillon-Limousin). 

Arecoline  C8  HI3  NO2  is  a  volatile  oil,  miscible  in  all  propor- 
tions in  water,  alcohol,  ether  or  chloroform.  It  forms'  crystalline 
salts,  and  is  pronounced  very  toxic.  It  exists  in  the  nut  in  the  pro- 
portion of  about  o.i  per  cent. 

In  doses  of  0.025 — 0.050  hypodermically  it  killed  a  large  rabbit ; 
0.020  killed  a  cat  and  0.075  killed  a  dog.  The  heart -beats  lessened 
until  they  ceased,  the  inspirations  being  augmented.  (Bocquillon- 
Limousin.) 

Arecoline  hydrobromate  occurs  in  white  crystals,  soluble  in.  wa- 
ter and  in  alcohol.  The  dose  for  a  horse  is  given  as  0.03 — 0.06  (gr. 

/2-I). 

Physiologic  Action  and  Therapeutics. — Marme  says  arecoline  re- 
sembles muscarine  in  its  action  on  the  heart,  and  depresses  respira- 
tion. Fohner  says  arecoline  hydrobromate  stimulates  the  salivary 
glands  more  powerfully  than  pilocarpine  and  is  a  more  active  laxa- 
tive than  physostigmine. 

It  is  especially  used  for  colic  of  horses,  in  doses  of  0.3 — 0.6 
(gr.  v — x)  evidently  a  mistake  for  0.03 — 0.06;  to  men  for  tenia 
0.004 — 0.006  (gr.  1-15 — i-io),  and  as  a  myotic.  Dropped  in  the  eye 
in  i-per-cent  solution  it  produces  violent  mycosis,  reaching  its 
maximum  in  10  and  beginning  to  subside  in  30  minutes.  (Lavagna.) 
In  i*/2  hours  the  pupil  is  still  somewhat  enlarged.  Intraocular  ten- 
sion is  not  modified.  Increased  refraction  from  ciliary  spasm  pre- 
ceded iris  dilation. 


34  ARSENIC 

In  glaucoma  Lavagni  and  Bietti  pronounce  it  superior  to  phy- 
sostigmine  though  les&  enduring  in  effect. 

Chetwood-Aiken  confirms  this  opinion.  No  headache  or  other 
unpleasant  after-effect  is  noted,  as  after  physostigmine.  He  uses 
^-per-cent  solutions.  A  drop  of  i-per-cent  solution  instilled  into 
the  eye  causes  lacrymation  and  ciliary  spasm  for  a  minute,  slight 
hyperemia  and  subcorneal  injection  subsiding  in  a  few  minutes ;  in 
two  minutes  violent  clonic  spasms  of  the  iris  with  dilatation  of  the 
pupils. 

The  point  of  especial  interest  to  us  is  the  effect  of  arecoline  in 
stimulating  peristalsis.  If  this  effect  can  be  produced  by  doses  too 
small  to  cause  suffering,  it  is  an  inestimable  remedy ;  as  it  can  be 
administered  hypodermically.  We  would  suggest  that  for  this  pur- 
pose a  dose  of  o.ooi  (gr.  1-67)  be  employed  and  modified  accord- 
ing to  results.  A  significant  statement  in  Dr.  Thomson's  report  is 
that  the  pain  occasioned  by  a  full  dose  does  not  last  long,  but  that 
the  cathartic  action  continues  much  longer. 

ARSENIC. 

Standard  granules — Arsenic  bromide,  gr.  1-67,  gm.  .001 ;  arsenic  iodide.gr. 
1-67,  gm.  ooi ;  arsenic  sulphide,  gr.  1-67,  gm.  .001 ;  arsenous  acid,  gr.  1-67, 
gm.  .001 ;  antimony  arsenate,  gr.  1-67,  gm.  .001  ;  caffeine  arsenate,  gr.  1-67, 
gm.  .001 ;  copper  arsenite,  gr.  1-67,  gm.  .001 ;  copper  arsenite,  gr.  i-iooo,  gm. 
.0000625;  copper  arsenite,  gr.  1-250,  gm.  .00025;  copper  arsenite,  gr.  i-ioo,  gm. 
.0007;  iron  arsenate,  gr.  1-67,  gm.  .001;  iron  arsenate,  gr.  1-6,  gm.  .01;  potas- 
sium arsenate,  gr.  1-67,  gm.  .001;  quinine  arsenate,  gr.  1-67,  gm.  .001;  quinine 
arsenate,  gr.  1-6,  gm.  .01 ;  sodium  arsenate,  gr.  1-67,  gm.  .001 ;  strychnine  ar- 
senate, gr.  1-134,  gm.  .0005;  strychnine  arsenate,  gr.  1-67,  gm.  .001;  strychnine 
arsenate,  gr.  1-30,  gm.  .002 ;  triple  arsenates ;  triple  arsenates.  with  nuclein. 

No  remedy  has  been  so  persistently  advocated,  in  so  many  diverse 
maladies  and  so  extensively  administered  and  lauded  as  arsenic.  And 
yet,  a  few  years  since  an  eminent  American  writer  challenged  the 
medical  profession  to  produce  one  solitary  instance  in  which  unmis- 
takable and  undeniable  benefit  had  accrued  from  the  use  of  this 
medicine.  It  has  seemed  advisable  therefore,  that  inquiry  should 
be  made,  and  the  known  facts  concerning  arsenic  placed  fairly  be- 
fore the  readers  of  this  work,  that  they  may  judge  ,for  themselves 
on  what  basis  the  employment  of  this  metal  as  a  medicine  rests,  and 
the  evidence  for  and  against  its  use. 

In  the  preparation  of  this  paper  every  accessible  source  has  been 
drawn  upon ;  and  Dr.  Epstein  has  especially  searched  through  the 


ARSENIC  35 

Russian  and  German  works  for  material.  It  has  been  impossible  to 
credit  every  statement  made  to  its  original  author,  but  so  far  as  pos- 
sible the  authority  has  been  given.  In  the  therapeutics  of  arsenic 
Ringer  was  the  pioneer  of  small  dosage,  which  he  first  introduced 
to  modern  medicine.  For  this  he  met  much  harsh  criticism ;  and 
the  opprobrious  epithet,  "disguised  homeopath,"  was  hurled  at  him 
from  all  sides ;  as  it  is  now  being  projected  at  some  other  innovators  ; 
yet  he  and  his  suggestions  survived,  and  the  latter  have  been  copied 
almost  verbatim,  with  or  without  credit,  by  nearly  every  writer  of 
therapeutic  text-books  since  his  work  first  appeared. 

Toxicology. — Arsenic  is  so  extensively  employed  in  the  arts  at 
present  that  both  the  acute  and  the  chronic  forms  of  arsenical  poison- 
ing are  common.  Arsenic  exists  in  considerable  quantities  in  com- 
mercial sulphuric  and  muriatic  acids,  and  hence  enters  many  drugs 
and  articles  of  commerce  in  whose  preparation  these  acids  are  em- 
ployed. Toxic  effects  have  been  noted  from  the  arsenic  in  sulphuric 
acid  used  in  galvanic  cells  and  in  that  used  in  preparing  glucose, 
from  which  poisonous  beer  has  been  brewed  (Liebreich). 

All  the  numerous  bismuth  salts  are  sometimes  contaminated  by 
arsenic  and  glycerin  containing  this  impurity  has  proved  toxic. 
Much  damage  is  done  by  the  arsenic  retained  by  aniline  dyes. 
Scheele's  and  Schweinfurth'&  greens  are  also  responsible  for  many 
toxic  accidents.  Not  only  the  greens  but  many  other  colors,  used  in 
dyeing  domestic  goods  and  tinting  wall-paper,  are  arsenical.  Wax 
tapers  containing  arsenic  set  free  highly  poisonous  gases  during 
combustion.  Rat  and  fly  poisons  are  generally  arsenical.  Even  if 
the  wall-paper  showing  is  free  from  arsenic  there  may  be  some  in 
the  paste  or  in  the  old  paper  underneath. 

Velour  tapestry,  tarlatan,  stuffed  birds  cured  with  arsenic,  arti- 
ficial flowers  and  white  muslin,  have  done  harm  by  setting  free 
arsenical  dust. 

In  the  arts  many  cases  of  poisoning  occur  from  inhalation  of 
arsenureted  hydrogen,  an  unpleasantly  smelling  and  highly  danger- 
ous gas. 

Arsenic  is  alike  toxic  when  taken  into  the  body  by  the  stomach  or 
subcutaneously,  inhaled  as  dust  or  gas,  or  when  applied  to  the  sur- 
face of  wounds,  from  which  it  is  readily  absorbed. 

Wines  have  been  found  to  contain  arsenic  in  France.  In  London 
milk  was  diluted  with  arsenical  water. 

There  is  little  uniformity  in  arsenical  poisoning,  the  symptoms 
varying  with  the  form  in  which  it  i&  taken,  the  dose  and  especially 


36  ARSENIC 

the  solubility.  Arsenical  gases  are  most  virulent;  while  the  metal 
itself,  unoxidized,  is  not  toxic,  a  cat  having  survived  a  dose  of  14 
grams  (over  3  drams). 

When  large  doses  of  arsenic  have  been  taken  there  may  be  no 
symptoms  for  half  an  hour  or  more ;  then  a  sense  of  tightness  in  the 
throat  comes  on,  with  difficulty  in  swallowing,  gastric  uneasiness, 
followed  by  gastric  pain  and  cramps,  vomiting  and  purging  with 
rice-water  stools  later.  The  symptoms  closely  resemble  those  of 
cholera  morbus.  Blood  appears  in  the  matter  vomited,  and  some- 
times in  the  stools.  The  urine  is  diminished  or  suppressed.  With 
these  occur  giddiness,  headache,  cold  sweats,  pallid,  shrunken 
features,  weak,  thready,  or  imperceptible  pulse,  feeble,  sighing  res- 
piration, muscular  cramps  if  the  loss  of  fluid  is  great  and  coma  end- 
ing in  death,  sometimes  preceded  by  convulsions  (Cushny).  The 
burning  pain  in  the  stomach  never  ceases  while  consciousness  re- 
mains1. Cramps  of  the  oesophagus  are  frequent.  Thirst  is  violent. 
The  voice  is  rough  and  the  tongue  usually  dry,  but  sometimes  saliva- 
tion occurs.  Tenesmus,  strangury  and  hematuria  have  been  ob- 
served. The  countenance  is  anxious,  the  patient  restless.  The  pulse 
slows  as  death  approaches,  and  consciousness  weakens.  These 
symptoms  may  continue  from  a  few  hours  to  as  many  days,  accord- 
ing to  the  dose.  If  death  occurs  speedily  it  is  due  to  the  nervous  in- 
fluence and  the  circulation  effects  (Liebreich).  If  the  dose  is  below 
the  lethal,  or  is  largely  vomited,  the  patient  may  recover  completely 
or  pass  into  chronic  arsenical  poisoning.  Sometimes  the  only  symp- 
toms are  collapse  and  coma. 

The  fatal  dose  is  uncertain.  As  arsenic  is  very  difficult  of  solu- 
tion it  is  doubtful  how  much  is  active  at  a  given  time.  Recovery 
has  followed  the  ingestion  of  very  large  doses,  while  o.i  (gr.  il/2} 
has  caused  death  (Cushny). 

Arsenous  acid  i&  the  most  frequent  cause  of  arsenical  poisoning. 

The  first  indication  is  to  wash  out  the  stomach  repeatedly.  Fats 
lessen  the  solubility  of  arsenic  and  perhaps  protect  the  exposed  sur- 
faces and  should  be  given  freely.  Magnesia  has  some  value  as  a 
chemical  antidote,  but  the  most  highly  favored  remedy  is  iron,  the 
freshly  precipitated  sesquioxide  or  dialyzed  iron.  These  form  a 
comparatively  insoluble  compound  with  arsenic.  That  it  is  not 
wholly  insoluble  is  shown  by  the  therapeutic  activity  of  iron  arsenate, 
hence  evacuants  should  follow  the  use  of  the  iron.  To  prepare  the 
hydrated  sesquioxide  of  iron,  mix  a  solution  of  iron  sulphate  or 
chloride  with  any  alkali,  soda  is  best,  and  strain.  An  excess  of  alkali 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


ARSENIC  37 

is  to  be  avoided,  as  this  would  cause  resolution  of  the  arsenical  pre- 
cipitate. As  the  quantity  of  arsenic  ingested  is  rarely  known,  the 
antidote  should  be  given  profusely,  "by  handfuls."  For  the  collapse, 
warmth,  caffeine  and  other  stimulants  are  required. 

When  the  arsenic  has  entered  the  circulation,  when  other  forms 
of  arsenic  have  been  given,  and  when  arsenical  gases  have  been  in- 
haled, we  are  powerless  except  as  to  treating  the  symptoms  and  sus- 
taining the  strength. 

Chronic  arsenical  poisoning  may  be  caused  by  a  single  dose,  but 
usually  it  is  due  to  the  continued  absorption  of  small  quantities. 
Brouarclel  divides  the  course  into  four  phases*: 

1.  The  victim  complains  of  weakness,  languor,  anorexia,  nausea 
or  vomiting,  weight  and  uneasiness  in  the  stomach,  diarrhea  or  con- 
stipation. 

2.  The  conjunctiva  are  red,  the  lids  itch ;  coryza,  sneezing  and 
coughing  occur;  the  liver  may  swell  with  jaundice;  papules,  vesicles 
or  erythema   appear  on   the   skin,   with   pigmentation   of  the  skin 
on     the    anterior    surface    of    the    body     from    the    nipples    to 
the     upper    thighs     and    in    the     axillae    or    other   parts.       There 
may  be  brown    circumscribed    patches.     This    pigmentation    gen- 
erally disappears    when    the  arsenic    is>    suspended,    but    may    be 
permanent.     In  prolonged  poisoning  the  eruptions   may   resemble 
almost  any  skin  disease,  the  hair  and  nails  may  fall,  and  deep  gan- 
grenous ulceration  has  been  observed. 

3.  Sensation  and  motion  are  disturbed,  in  limited  areas,  often 
in  the  hands  and  feet.     There    is    intense,    persistent    headache,  or 
acute  pain  in  knee,  ankle  or  foot,  less  often  in  the  upper  extremity ; 
formication,  the  pressure  of  bedding  on  the  legs  and  feet  is  uncom- 
fortable ;  sensory  paralysis  follows,  the  sense  of  touch  is  weakened, 
those  of  cold,  heat,  or  pain  increased  or  lessened.    Symptoms  closely 
resembling  locomotor  ataxia  may  occur,  especially  in  subacute  cases ; 
coordinative  disturbances,  absence  of  patellar  reflexes,  and  light- 
ning pains,  may  simulate  ataxia. 

4.  Motor  paralysis  follows  usually  in  the  extensors  of  the  toes, 
then  in  the  peroneal  group ;  rarely  in  the  flexors  of  the  foot  and  leg, 
or  the  extensors  of  the  hands  and  fingers.     Usually  the  paralysis  is 
confined  to  the  extremities  but  it  sometimes  extends  to  the  trunk. 
It  is  usually  symmetrical ;  the  affected  muscles  atrophy  rapidly,  and 
respond  slightly  to  galvanism,  but  not  to  faradism  except  at  first. 
This  diminution   of  excitability  may  appear  before  the  reaction  of 


38  ARSENIC 

degeneration,  which  then  follows.  Mechanical  stimuli  excite  the 
muscles  abnormally. 

Lead  paralysis  may  be  distinguished  by  the  history  of  prolonged 
poisoning,  the  sensory  ailments  occur  later,  the  forearm  is  usually 
first  affected,  there  is  the  lead  line  on  the  gums,  and  atrophy  of  the 
muscles  occurs  much  later. 

Arsenical  paralysis  may  appear  three  days  after  acute  poison- 
ing, but  usually  occurs  later,  perhaps  not  for  a  month.  The  sexual 
function  may  be  stimulated  or  depressed.  In  subacute  cases  the 
stomach  may  reject  everything  swallowed,  and  great  emaciation  re- 
sult. In  prolonged  cases  the  victim  may  sink  into  an  apathetic, 
demented  or  epileptic  state. 

Usually  when  the  poison  is  withdrawn  the  symptoms  gradually 
subside,  but  gastric  irritability,  contractures,  sensory  disturbances 
and  paresis  may  remain.  Weak  vision,  mild  optic  neuritis  and 
amblyopia  have  been  noted.  If  degeneration  of  the  muscles  has  oc- 
curred little  improvement  is  to  be  expected.  Herpes  zoster  occurs 
sometimes  on  the  face  or  on  the  trunk.  Some  of  the  skin  affec- 
tions seen  are  due  to  the  direct  action  of  the  drug ;  in  men  handling 
it,  the  malady  first  appearing  on  the  hands  is  then  carried  to  the 
nose,  arms  and  genitals.  On  the  genitals  a  characteristic  ulceration 
sometimes  occurs,  termed  "arsenical  chancre."  The  absence  of 
glandular  swelling,  the  slight  hardening  and  the  history,  serve  to  dis- 
tinguish these  from  the  specific  chancre.  Blisters,  urticaria,  eczema 
and  erythema  may  occur. 

The  phases  of  Brouardel  are  not  always  distinct,  the  symptoms 
of  the  second  sometimes  appearing  first  and  those  of  the  others  to- 
gether. When  arsenic  is  given  medicinally  the  first  symptoms  of 
saturation,  or  toxic  action,  are  redness,  inflammation  and  itching  of 
the  eyelids  and  conjunctive,  with  dry  nose  and  throat,  or  coryza. 
Workmen  inhaling  arsenical  dust  suffer  bronchial  irritation  or 
cutaneous  disorders. 

Physiologic  Action. — In  the  alimentary  canal  arsenic  produces 
effects  similar  to  those  of  corrosives ;  it,  however,  does  not  coagulate 
or  unite  with  albumin.  The  mucous  membrane  is  red  and  swollen, 
the  epithelium  fatty,  sometimes  showing  ecchymoses.  The  whole 
or  parts  of  the  gastric  mucosa  may  be  affected.  If  solid  arsenic  lies 
long  on  the  membrane,  erosions  may  be  formed.  From  these  red 
lines  lead  along  the  sulci  where  the  dissolved  arsenic  ran.  Some- 
times the  only  lesion  is  the  cloudy  swelling  of  the  fatty  gland-cells. 

The  bowels  present  a  similar  appearance,  most  marked  around 


ARSENIC  39 

Peyer's  patches.  Even  after  profuse  vomiting  and  purging  small 
particles  of  arsenic  may  be  found.  The  pharynx  and  oesophagus 
may  be  congested.  From  the  stomach  downward  the  appearances 
become  less  marked,  being  least  in  the  rectum.  The  gastric  lesions 
are  rarely  due  to  direct  contact  with  the  arsenic,  and  are  caused  by 
its  excretion,  with  the  aid  of  the  gastric  juice  (Filehne).  The 
bowels  contain  the  "rice-water"  material  and  necrosed  epithelium  in 
profusion. 

The  liver  shows  marked  parenchymatous  turbidity,  fatty  degen- 
eration and  necrotic  spots. 

Boehm  attributes  the  gastro-intestinal  lesions  to  the  action  of  the 
arsenic  causing  extreme  dilatation  of  the  blood-vessels,  with  conse- 
quent congestion  and  destruction  of  the  epithelium,  and  transuda- 
tion  of  serum  beneath  it. 

Schmiedeberg  thinks  that  arsenic  has  a  specific  action  in  causing 
fatty  degeneration  of  the  gastro-intestinal  epithelium.  This  de- 
structive action  may  be  beneficial  when  present  in  the  mild  degree 
following  the  use  of  arsenic  in  medicinal  doses,,  promoting  appetite 
and  digestion.  In  the  spinal  cord  arsenic  induces  localized  myelitis. 
The  rapid  respiration  at  first,  and  paralysis  of  the  vasomotor  centers, 
indicate  a  direct  action  on  the  medulla.  Tenderness  of  the  nerve- 
trunks  points  to  peripheral  neuritis,  and  this  may  ascend  to  the  cord ; 
or,  vice  versa  (Cushny). 

The  pulse  is  accelerated  by  small  doses  and  slowed  by  large  ones, 
inhibition  being  unaffected.  The  vascular  tension  rises  at  first,  fall- 
ing soon  after  large  doses;  the  vasomotor  centers  and  later  the 
splanchnic  nerves  losing  control  over  the  vessels  (Pistorius). 

The  vascular  pressure  may  be  restored  by  stimulating  the  vaso- 
motor center,  but  only  at  first ;  while  splanchnic  stimulation  still  in- 
creases the  tension.  Later,  these  nerves  fail,  through  paralysis  of 
their  ends  or  of  the  vessel  walls,  while  other  vasoconstrictors  can 
still  contract  the  vessels. 

Respiration  is  hastened  at  first  by  small  doses,  then  returns  to 
normal.  Later,  it  ceases  before  the  heart  stops  from  exhaustion  and 
low  blood-pressure. 

If  arsenic  is  applied  to  the  unbroken  skin  it  is  unaffected  unless 
contact  is  continued,  when  redness,  vesicles,  pustules  and  later 
violent  erythema  appear.  There  is  no  corrosion,  and  subcutaneous 
injections  of  arsenic  are  painless.  Applied  to  denuded  surfaces  or 
mucous  membranes  it  causes  acute  pain  and  slowly  destroys  the  tis- 
sues. It  acts  only  on  living  cells*,  not  on  dead  tissues.  When  animals 


40  ARSENIC 

are  taking  arsenic  the  epidermis  peels  off  easily  (Ringer).  This  is 
due  to  softening  of  the  protoplasm  in  the  deeper  epidermal  cells 
(Nunn).  Similar  changes  occur  in  the  eye.  The  melanosis  seems 
to  be  due  to  the  deposition  of  some  organic  product  in  the  deeper 
layers  of  the  corium.  Mucous  irritations  are  caused  by  the  excre- 
tion of  arsenic  on  their  surfaces.  Arsenic  has  been  found  in  the 
serum  of  blisters  of  animals  taking  the  drug  (Cushny). 

On  the  blood  the  action  of  arsenic  is  obscure.  It  lessens  the 
number  of  red  corpuscles,  but  not  the  total  hemoglobin.  In  per- 
nicious anemia  it  increased  the  number  of  young  red  cells  while  the 
mature  cells  lessened  (Engel).  Silbermann  says  it  induces  wide- 
spread intra vascular  coagulation,  leading  to  a  fall  in  blood-pressure 
and  to  anemia.  Heinz  adds  that  arsenic  also  induces  thrombi  of 
blood-plates,  which  cause  the  ecchymoses  and  ulcers. 

Fever  is  sometimes  present  in  arsenical  poisoning,  due  to  the  in- 
flammations. Metabolism  is  affected  by  arsenic,  the  nitrogen  in  the 
urine  is  increased,  ammonia  is  augmented  and  the  alkalinity  of  the 
blood  is  reduced  by  the  formation  of  lactic  acid  in  excess.  The 
glycogen  entirely  disappears  from  the  liver  and  is  not  formed  from 
the  food.  Puncture  of  the  medulla  does  not  cause  glycosuria, 
though  curarine  still  elicits  it.  Fatty  degeneration  of  the  epithelium 
is  found  in  the  liver,  kidney,  heart-muscle,  blood-vessels,  striated 
muscles  and  pulmonary  alveoli.  Necrotic  foci  are  found  in  the  liver 
with  active  division  of  the  hepatic  cells  (Wolkow). 

Cushny  sums  up  these  effects  by  stating  that  arsenic  lessens  the 
oxidation  of  the  tissues  and  causes  fatty  degeneration  of  the  proto- 
plasm ;  it  may  increase  the  waste  of  proteids,  directly  or  secondarily 
to  the  decrease  in  oxidation.  These  effects  are  simply  less  in  degree 
than  those  of  phosphorus.  Improvements  in  nutrition  from  the  pro- 
longed use  of  arsenic  in  medicinal  doses  is  well  attested.  Weiske 
explains  this  by  the  theory  that  more  food  is  digested  and  less  pro- 
teid  decomposed. 

Arsenicophagi. — Tolerance  is  sometimes  established  when  ar- 
senic is  taken  habitually.  The  Styrian  peasants  who  eat  arsenic 
believe  it  enables  them  to  work  better,  to  climb  mountains  with  less 
effort,  especially  of  the  lungs,  that  it  improves  their  complexions, 
makes  their  horses'  coats  glossy,  and  the  animals  stronger  and  fatter. 
Arsenic  is  said  to  be  taken  by  these  men  up  to  0.5  (gr.  7^2)  at  a 
dose,  but  Murrell  puts  the  maximum  daily  dose  at  slightly  more  than 
Yz  grain.  These  peasants  are  "said  to"  live  to  old  age,  with  no  evil 
results,  and  to  enjoy  unusual  sexual  powers.  And  on  this  "say  so" 


ARSENIC  41 

is  largely  based  the  use  of  arsenic  as  a  remedy.  Experiments  on 
animals  have  not  created  toleration  but  chronic  poisoning;  and  the 
allegations  as  to  increased  endurance  of  fatigue  by  arsenic  eaters 
are  as  yet  unproved,  and  contrary  to  modern  scientific  observations. 

A  review  of  these  accounts  shows  that  the  good  effects  are  not 
uniform,  but  that  many  die  from  the  drug;  that  the  habit  renders 
its  continued  use  necessary ;  and  that  the  alleged  benefits  are  no  more 
than  could  be  ascribed  to  the  healthy  life  of  the  mountaineer,  whose 
great  respiratory  capacity  is  necessitated  by  the  attenuated 
atmosphere. 

The  observations  of  Schallgruber,  von  Tschudi  and  others,  of  the 
Styrian  arsenic  eaters,  appear  so  contradictory  to  the  common  ex- 
perience of  the  scientific  world  in  general,  that  some  further  in- 
vestigation seems  desirable.  Gies  experimented  on  animals  with  the 
following  results : 

1.  Badly  nourished   rabbits  could   not  bear  the  smallest   daily 
doses  of  arsenic   (0.0005 — 0.002),    but    became    progressively    de- 
jected, refused  to  eat,  developed  diarrhea,  emaciated,  the  coat  be- 
came rough,  and  died  within  three  and  a  half  weeks.     The  autopsy 
showed  always  catarrh  of  the  stomach  with  thickened  mucosa,  fatty 
liver  and  other  evidences  of  arsenical  poisoning. 

2.  Young,  immature  rabbits,  pigs  and  chickens,  tolerated  the 
above  doses  very  well,  and  as  shown  by  comparison  with  control 
animals,  grew  stronger  and  larger  in  all  ways,  more  energetic,  with 
finer,  sleeker  coats,  fatter,  the  bones    longer    and    thicker.      Their 
young  also  were  superior  in  size,  strength   of   bones    and    size   of 
thymus,  but  were  born  dead — possibly  by  reason  of  their  abnormal 
size.     But  animals  kept  in  cages  with  those  fed  on  arsenic,  or  with 
arsenic  scattered  under  the  perforated  bottom  of  the  cages,  showed 
the  same  improvement,  though  to  a  less  degree. 

3.  Full-grown  rabbits  given  arsenic  acid,  0.0005  daily  for  40 
days,  did  well,  fattened,  and  had  a  thick  layer  of  arsenic  in  the  cortex 
of  the  diaphyses,  but  not  in  the  epiphyses,  where  growth  had  ceased. 
But  the  liver,  heart  and  kidneys  were  fatty  (degenerated). 

4.  None  of  the  animals  could  be  habituated  to  the  higher  doses ; 
for  when  the  metal  was  increased  the  bone-changes  (especially  in 
hens)  stopped,  and  signs  of  chronic  poisoning  appeared,  emaciation, 
falling  of  hair,  intense  gastrointestinal  hyperemia,  with  violent  purg- 
ing, and  extensive  fatty  degeneration  of  the  heart,  liver,  kidneys  and 
perhaps  the  spleen. 

Schsefer  records  thirteen  sudden  deaths  among  arsenic  eaters  in 


42  ARSENIC 

Gratz  alone  within  two  years.  Toxic  symptoms  also  frequently  ap- 
peared in  persons  taking  minimal  doses. 

From  the  facts*  Nothnagel  concludes  that  arsenic  habituation, 
even  to  minimal  doses,  is  by  no  means  a  rule  without  exceptions,  and 
that  the  physician  prescribing  this  drug  should  carefully  ascertain 
the  patient's  resistance  to  it. 

But  Knapp  produced  a  man  who  swallowed  at  one  dose  0.4  (gr. 
vj )  of  arsenic  acid,  with  impunity.  Hebra  gave  0.06  daily ;  and 
Kaposi  22.5  grams  in  a  year  to  one  case.  However,  the  duration  of 
tolerance  has  not  been  determined,  nor  whether  death  does  not  finally 
result  from  the  arsenic.  Knapp  recovered  from  the  urine  of  arsenic 
eaters,  0.032  to  0.029  of  the  metal,  showing  that  that  quantity 
traversed  the  system  daily  without  symptoms  of  chronic  arsenic 
poisoning. 

The  residents  of  Whitbeck,  England,  use  an  arsenical  water 
habitually.  Beginners  experience  dryness  of  the  mouth  and  throat, 
1  but  this  quickly  passes  off.  These  people  are  said  to  reach  old  age 
as  a  rule;  a  statement  that  needs  confirmation.  While  the  Styrians 
are  said  to  take  as  much  as  1.5  grain  (Heisch)  per  diem,  or  once  a 
week  perhaps,  the  Whitbeck  people  take  much  less.  Arsenic  eaters 
avoid  drinking  just  after  taking  the  poison,  and  some  avoid  fats. 
Some  suspend  the  arsenic  and  take  purgatives  at  times.  The  women 
are  said  to  get  fat,  with  pure  complexions  and  rosy  color ;  but  I  have 
never  been  able  to  obtain  this  effect  from  arsenic.  On  the  contrary, 
the  American  women  who  take  arsenic  become  dark,  even  like  the 
victims  of  Addison's  disease. 

The  mountaineer  believes  arsenic  improves  his  lungs,  so  that  he 
can  climb  without  fatigue  or  dyspnea.  The  disuse  of  the  drug,  is 
followed  by  weakness  in  this  respect,  which  disappears  when  it  is 
resumed.  Whether,  however,  those  who  do  not  use  arsenic  do  not 
develop  equal  lung-power,  is  not  settled.  It  is  admitted  that  arsenic 
does  not  always  produce  the  good  effects  described,  and  that  large 
doses  entail  serious  inconvenience.  Even  Tschudi  admits  that  some 
become  sick  and  marasmic  from  the  drug.  Arsenical  paralyses*  are 
rarely  seen. 

Excretion.  — Arsenic  is  largely  excreted  by  the  kidneys,  to  a  less 
degree  by  the  gastrointestinal  and  respiratory  mucous  membranes, 
traces  being  found  in  the  skin,  hair  and  milk.  Fatal  intoxication 
occurred  in  a  child  whose  mother  suffered  acute  arsenical  poisoning. 
Excretion  is  slow,  arsenic  being  detected  in  the  urine  three  months 
after  it  was  last  taken.  The  effects  remain  long  after  the  drug  has 
been  excreted. 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


ARSENIC  43 

Arsenic  is  found  most  largely  in  the  liver;  also  in  the  kidneys, 
stomach,  intestines,  spleen,  lungs,  and  traces  in  the  muscles  and 
nervous  tissues.  In  the  blood  it  is>  found  in  the  cells.  It  has  been 
found  in  the  bones  after  having  disappeared  from  the  other  tissues. 

As  an  antiseptic,  arsenous  acid  is  one-tenth  as  strong  as  corrosive 
sublimate.  The  spores  of  anthrax  are  destroyed  only  after  ten  days' 
immersion  in  i-iooo  solution  (Koch).  It  has  no  action  on  ferments, 
moulds  and  algre.  The  bodies  of  persons  dying1  from  arsenical 
poison  are  said  to  remain  long  undecomposed,  but  this  is  disputed. 

Binz  and  Schultz  explain  the  action  of  arsenic  by  supposing  that 
arsenous  acid  is  oxidized  into  arsenic  acid  in  the  tissues,  and  the 
arsenic  acid  again  reduced  to  arsenous.  Oxygen  is  thus  alternately 
withdrawn  from  and  again  supplied  to  the  protoplasm. 

Arsenureted  hydrogen  is  exceedingly  poisonous  and  many 
fatalities  occur  from  its  inhalation  in  laboratories.  It  acts  as  a 
molecule,  AsH3,  arsenites  as  ions.  It  destroys  the  red  corpuscles, 
inducing  intense  headache,  nausea,  vomiting,  prostration,  syncope, 
cyanosis  and  collapse.  The  hemoglobin  is  reduced.  Methemoglobin, 
hematin  and  even  blood  are  passed  in  the  urine.  Rarely  the  stools 
contain  blood.  The  uriniferous  tubules  may  be  plugged  by  debris. 
Intense  jaundice  may  occur.  Death  is  due  to  pulmonary  redema  or 
to  heart-failure.  The  gas  may  be  excreted  by  the  lungs  and  is 
known  by  the  garlic  odor.  The  absorption  band  of  oxyhemoglobin 
disappears  before  this  is  reduced,  when  further  decomposition  of  the 
blood  takes  place  (Liebreich). 

Bunsen  asserted  that  cacodylic  acid  compounds  are  non-toxic, 
but  Schulz  has  shown  this  to  be  erroneous.  Loew  has  shown  that 
when  arsenous  acid  is  injurious  to  plants  it  is  only  as  an  acid  injur- 
ing the  protoplasm,  since  spirogyra  thrives  in  .water  containing  2 
per  cent  of  arsenic  acid  neutralized  by  potash. 

Therapeutics. — In  spite  of  the  very  full  account  given  of  the 
effects  of  arsenic  in  the  human  body,  we  are  struck  with  the  fact  that 
scarcely  a  single  therapeutic  use  of  this  agent  is  deducible  therefrom. 
Excepting  the  possible  use  of  arsenic  in  diabetes  mellitus,  we  have 
only  the  hazardous  surmise  that,  since  arsenic  physiologically  affects 
certain  tissues,  such  as  the  skin,  it  may  possibly  be  found  effective  in 
combating  pathologic  conditions  of  these  tissues.  But  arsenic  acts 
as  a  poison,  first  and  last ;  and  the  indications  for  its  use  are  purely 
empirical.  It  is  questionable  whether  the  constantly  recurring  ad- 
vocacy of  arsenic  as  a  remedy  in  all  sorts  of  maladies,  especially 
those  usually  considered  incurable,  such  as  carcinoma  and  tuber- 


44  ARSENIC 

i 

culosis,  is  not  due  to  the  somewhat  superstitious  idea  of  its*  powers 
arising  from  its  alleged  use  by  the  Styrian  arsenicophagi.  This  tale 
seems  to  have  been  accepted  for  generations  with  very  little  attempt 
at  verification ;  and  even  if  these  people  have  acquired  a  hereditary 
immunity  against  arsenic,  which  has  not  been  claimed,  but  might  be, 
the  experience  is  altogether  exceptional,  and  nothing  like  it  has  been 
observed  in  other  races  and  lands.  Altogether  the  tale  bears  many 
of  the  earmarks  of  a  "traveler's  yarn,"  so  far  as  the  good  effects  of 
the  habit  are  concerned. 

In  the  skin  we  look  for  the  first  evidences  of  therapeutic  action. 
On  syphilitic  dermatoses  arsenic  has  no  effect.  On  general  eczema, 
especially  the  chronic  forms,  psoriasis,  urticaria,  lichen,  and  some- 
times'  on  pemphigus,  leukemia  and  pseudoleukemia,  arsenic  has  a 
beneficial  effect.  Acne  is  benefited  in  proportion  as  the  general 
health  improves,  but  rosacea  is  improved  or  cured.  Over  lepra, 
arsenic  has  no  control,  nor  over  furunculosis.  The  drug  should  be 
commenced  in  minute  doses,  increased  until  toxic  action  begins, 
when  the  curative  effect  should  be  manifested. 

Chronic  affections  require  chronic  treatment,  and  in  lichen  ruber 
Ilebra  gave  arsenic  for  two  years. 

Malignant  lymphoma  can  be  cured  by  arsenic.  During  each 
decade  of  the  last  century  arsenic  was  brought  forward  as  a  cure  for 
cancer  and  in  each  case  the  claim  was  disproved  (Nothnagel). 

Lipp  introduced  the  subcutaneous  injection  of  arsenic  in  lichen 
ruber  and  other  dermatoses.  The  method  has  value,  but  fatty  liver 
has  developed  under  it.  The  injections  are  apt  to  cause  abscess  un- 
less carefully  sterilized.  Sodium  arsenate  is  preferable  for  hypo- 
dermic use.  Little  benefit  will  follow  the  use  of  arsenic  in  skin  dis- 
eases unless  the  digestion  is  carefully  regulated. 

Buchner  believed  that  arsenic  renders  the  body  immune  against 
the  tubercle  bacillus,  but  this  has  been  disproved.  If  phthisis  is 
primarily  a  malnutrition  opening  the  way  to  the  bacillus,  it  is  easy 
to  conclude  with  Leyden  that  arsenic  can  have  no  effect.  Nor  does 
arsenic  develop  a  high  state  of  nutrition,  or  favor  the  elimination  of 
microorganisms.  Moreover  the  parasiticide  powder  of  arsenic  is 
slight,  and  it  cannot  hinder  the  multiplication  of  bacteria,  nor  has  it 
proved  effective  in  lupus,  even  in  toxic  doses,  where  its  decided  pre- 
dilection for  the  skin  would  render  its  use  advisable,  a  priori.  Yet 
Landerer  has  obtained  good  results  from  subcutaneous  injections  of 
arsenic  in  lupus. 

In  chronic  malaria  arsenic  has  proved  undoubtedly  a  very  ef- 


ARSENIC  45 

ficient  remedy.  After  the  sequence  of  chills  has  been  broken  by 
quinine,  arsenic  may  be  depended  upon  to  remove  the  relics  of  the 
malady.  Iron  is  usefully  conjoined. 

Pellagra  is  controlled  by  arsenic. 

In  diabetes  arsenic  has  been  employed  with  varying  effect. 
Arsenic  bromide  obtained  some  repute  in  this  affection.  The  evi- 
dence seems  to  show  that  arsenic  succeeds  only  in  exceptional  cases, 
and  as  yet  the  class  in  which  it  is  best  to  use  it  has  not  been  dis- 
tinguished. The  best  results  have  been  obtained  by  giving  the 
bromide  in  maximum  doses  for  several  weeks. 

In  neuralgia  arsenic  has*  been  largely  used  as  a  remedy  for  the 
intervals,  in  the  belief  that  it  exerts  a  useful  influence  over  the  nutri- 
tion of  the  nerve-centers.  The  fifth  cranial  nerve  has  been  thought 
to  come  most  directly  under  its  influence. 

Isnard  gives  arsenic  in  nearly  all  purely  functional  neuroses,  es- 
pecially "general  nervousness."' 

Romberg  thinks  most  benefit  is  obtained  when  reflex  neuralgia 
has  as  its  basis  uterine  or  ovarian  disease,  especially  if  the  patient  is 
anemic,  while  in  plethoric  cases  the  effect  may  be  hurtful. 

Chorea  usually  subsides  under  the  use  of  arsenic,  but  this  malady 
usually  subsides  in  six  or  eight  weeks  under  any  treatment.  In 
calisthenics,  macrotin,  hyoscine  and  cicutine,  with  personal  and 
moral  hygiene,  we  have  remedies  for  this*  affection  of  more  assured 
value. 

In  chorea  the  cause,  rheumatism,  psychic  influence,  etc.,  has  no 
influence  on  the  control  exerted  by  the  arsenic  (Nothnagel). 

Tremors  connected  with  centric  neuroses,  disseminated  sclerosis, 
etc.,  are  amenable  to  arsenic  hypodermically  (Eulenberg). 

Kuelz  and  Fuerbringer,  after  careful  experiments,  conclude  that 
the  apparent  benefit  from  arsenic  in  diabetes  is  due  to  the  lessened 
ingestion  of  sugar-forming  foods,  caused  by  the  gastric  irritation 
which  is  induced  by  the  remedy. 

In  that  form  of  cardialgia  occurring  usually  at  night,  without 
palpable  change  in  the  stomach,  in  middle-aged  persons  exposed  to 
mental  strain,  arsenic  is  the  only  useful  remedy  (Leared). 

In  malignant  lymphoma  arsenic  was  used  internally  and  injected 
into  the  gland,  with  a  decided  decrease  of  the  growth  and  even  a 
perfect  cure  (Billroth,  Czerny,  Winiwarter,  Israel,  Karewski  and 
Warfingh ) . 

One  case  of  general  cutaneous  sarcoma  was  cured  by  arsenic 
hypodermically  (Koebner). 


46  ARSENIC 

In  pernicious  anemia  arsenic  has  been  used  with  asserted  benefit, 
and  in  leukemia  it  has  been  given  internally  and  injected  under  the 
skin.  Judgment  deferred  (Nothnagel). 

Children  bear  arsenic  relatively  well.  In  old  age  it  easily  begets 
digestive  disturbances.  It  is  contra-indicated  by  gastric  irritations, 
and  fever,  not  malarial  (Nothnagel). 

Seguin  advised  large  dilution  with  water. 

Some  begin  with  small  doses  and  ascend,  others  the  contrary. 
When  evidences  o/  toxic  action  begin,  the  drug  must  be  stopped  at 
once. 

The  moderate  uses  of  arsenic  in  small  doses  may  be  traced  back 
through  all  the  modern  text-books  to  Ringer.  He  advised  this  agent 
in  several  forms  of  spasmodic  sneezing,  with  itching  beginning  at 
one  spot  in  the  naso-pharyngeal  mucous  tract,  tending  to  recur  more 
or  less  constantly  on  slight  provocation.  He  also  advised  arsenic 
for  rumination,  merycismus  or  the  regurgitation  of  food  without 
nausea,  for  chronic  bronchitis  with  free  discharge  of  thin  sputa,  in 
non-febrile  catarrhs,  and  the  early  stages  of  pulmonary  phthisis.  In 
rheumatic  gout  he  employs  a  bath  containing  four  ounces  of  wash- 
ing soda  and  a  scruple  of  sodium  arsenate. 

He  describes  an  affection  of  the  tongue  in  children,  a  circular 
rash,  beginning  at  a  point,  enlarging,  with  rings  coalescing  like  ring- 
worm, the  surface  abnormally  clean,  obstinate  and  prone  to  recur, 
and  associated  with  gastric  or  intestinal  ailments,  obstinate  diarrhea, 
or  lichen  urticatus.  In  this  arsenic  proves  useful. 

In  asthma  and  chronic  forms  of  phthisis  he  employs  cigarettes, 
made  by  saturating  blotting  paper  with  a  solution  of  fifteen  grains  of 
potassium  arsenate  in  an  ounce  of  water.  For  sloughing  of  the 
mucosa  of  mouth  or  throat,  malignant  sores,  chronic  coryza,  any 
malady  alternating  with  sneezing,  and  the  collapse  stage  of  a 
choleraic  attack,  he  praises  the  effect  of  arsenic.  Ringer  also  rec- 
ommends arsenic  in  small  doses  before  meals  in  anorexia,  gastric 
neuralgia,  lienteric  diarrhea,  irritative  dyspepsia,  gastralgia,  heart- 
burn, the  vomiting  of  drunkards,  or  of  gastric  ulcer  or  cancer.  In  a 
large  group  of  nervous*  maladies  this  metal  has  been  highly  praised  ; 
especially  in  tic  douloureux,  hemicrania,  neurasthenia,  angina 
pectoris,  chorea,  epilepsy,  asthma,  whooping-cough,  hay-fever;  as  a 
rule  being  best  given  in  the  intervals  to  prevent  the  recurrence  of 
paroxysms. 

Brunton  verifies  most  of  Ringer's  suggestions,  and  says  that  in 
malaria  arsenic  sometimes  acts  better  than  quinine,  and  as  a  rule 


ARSENIC  47 

excels  the  latter  in  latent,  masked  and  irregular  forms,  manifested 
otherwise  than  by  periodic  chills  and  fever.  As  a  prophylactic 
against  malaria  several  observers  place  arsenic  above  quinine. 
Brunton  strongly  urges  arsenic  in  catarrhal  pneumonia  with  de- 
layed resolution.  This  condition  offers  a  most  favorable  opportunity 
for  the  domiciliation  of  the  tubercle  bacillus.  Arsenic  attacks  the 
consolidation,  favoring  the  occurrence  of  fatty  degeneration,  soften- 
ing and  absorption,  and  hence  is  prophylactic  against  tuberculosis. 
1  would  advise  arsenic  iodide  for  this  purpose. 

Hunt  says  arsenic  is  harmful  during  the  inflammatory  stage  of 
eruptions ;  but  Erasmus  Wilson  gave  it  in  the  acute  stages  of  eczema, 
only  using  very  small  doses. 

Simpson  found  arsenic  useful  in  mucous  colitis  and  in  mem- 
branous dysmenorrhea.  In  the  former  malady  it  has  not  given  me 
as  good  results  as  the  silver  salts.  Murrell  alludes  to  the  effects  of 
arsenic  given  to  horses.  It  makes  the  coat  sleek  and  smooth,  but 
when  the  arsenic  habit  is  formed  the  animals  droop  and  suffer  if 
deprived  of  it. 

Shoemaker  pronounces  arsenic  the  only  known  remedy  that  has 
any  effect  in  restraining  the  development  of  visceral  cancer.  Wright 
regards  arsenic  bromide  as  the  best  remedy  against  cancer. 

Bryan  considers  arsenic  a  prophylactic  against  scarlatina  and 
possibly  influenza  and  diphtheria. 

Phillips  found  it  beneficial  in  scarlatinal  albuminuria.  It  is  said 
to  relieve  hemorrhoids,  and  certainly  relieves  the  rectal  excoriations 
common  in  those  subject  to  acidity  and  heartburn.  Sawyer  found 
arsenic  effective  in  those  cases  of  gastric  pain  where  the  taking  of 
food  gave  temporary  relief.  Sometimes  obstinate  forms  of  syphilis 
that  resist  mercury  and  iodine  improve  at  once  where  arsenic  is 
added  to  the  foregoing.  Drew  praised  arsenic  in  splenic  leuke- 
mia, and  Hare  advocates  it  also  in  leucocythemia  and  pseudoleuke- 
mia.  if  given  persistently  up  to  full  tolerance. 

It  has  been  advocated  in  amenorrhea  when  due  to  uterine  con- 
gestion, to  anemia  or  chlorosis.  Butler  advises  arsenic  in  Hodg- 
kin's  disease,  in  melancholy  and  hypochondria,  especially  of  the  aged. 

Sympson  gave  arsenic  internally,  continued  for  several  weeks, 
for  warts,  finding  that  they  gradually  disappear. 

Externally,  arsenic  is  used  as  an  application  to  cancerous 
growths.  The  effect  is  not  due  to  coagulation  but  to  a  devitalizing 
of  the  protoplasm.  In  lupus,  by  painting  with  Fowler's  solution, 
cicatrization  may  be  produced,  but  the  disease  is  only  veiled. 


48  ARSENIC 

In  the  form  of  Abbott's  paste  arsenic  is  employed  by  dentists  to 
kill  the  nerve,  when  the  dental  pulp  is  exposed.  A  bit  of  the  paste 
the  size  of  a  pin-head  is*  introduced  in  the  cavity,  first  cleaned  out 
and  dried  with  absorbent  cotton ;  then  a  bit  of  cotton  dipped  in 
damar  varnish  is  inserted  to  seal  the  cavity  and  prevent  communica- 
tion with  the  fluids  of  the  mouth. 

In  all  external  uses  of  arsenic  the  danger  of  poisoning-  by 
absorption  must  be  recollected. 

Brunton  advises  a  paste  of  arsenous  acid  two  drams,  cinnabar 
two  drams,  ashes  of  old  leather  eight  grains,  dragon's  blood  twelve 
grains,  with  water  or  saliva.  Any  arsenical  paste  should  contain 
at  least  20  per  cent  of  arsenic  in  order  that  the  destructive  action 
shall  be  thorough.  A  weaker  preparation  is  apt  to  cause  poisoning 
through  absorption  taking  place  before  the  tissue  has  been  de- 
vitalized. 

Hebra's  paste  consists  of  arsenous  acid  fifteen  grains,  cinnabar 
three  grains  and  an  emollient  ointment  twenty-four  grains. 

Marsden  mixed  one  ounce  each  of  arsenous  acid  and  acacia,  with 
five  drams  of  water.  Of  this  he  painted  several  coats  over  epithe- 
liomas,  carefully  confining  it  to  the  growth  and  covering  not  over 
one  square  inch  at  once.  This  is  a  good  rule  in  all  arsenical  caustic 
applications.  The  sloughing  tissue  should  be  removed  by  poultices. 
Some  cut  grooves  into  the  cancerous  mass  and  fill  with  the  paste, 
leaving  it  till  the  tissues  are  dead.  Hue  and  Paanel  injected  solu- 
tions of  r  to  1000  into  inoperable  cancers. 

Manec's  paste  consists  of  fifteen  grains  arsenous  acid,  seventy- 
five  grains  of  black  mercury  sulphide  and  thirty-five  grains  of  burnt 
sponge;  but  this  seems  too  weak  for  safety. 

Orpiment,  an  arsenical  ore,  is  sometimes  used  as  a  depilatory; 
one  part  with  five  of  slacked  lime  forming  "Rusma  Turcarum ;"  and 
five  parts  orpiment,  fifty  of  slacked  lime  and  thirty  of  starch,  form- 
ing Plenck's  depilatory.  The  latter  is  to  be  kept  in  a  well-stopped 
bottle  to  exclude  air.  A  little  is  moistened,  made  into  a  thick  paste 
and  applied  to  the  hairy  parts  for  a  short  time,  then  scraped  off 
with  a  dull  knife. 

Ringer  painted  corns  and  warts  with  Fowler's  solution ;  but  as  to 
corns  I  must  warn  against  the  use  of  every  species  of  caustic. 

In  administering  arsenic,  whenever  the  effect  desired  is  allaying 
pain  or  irritability  of  the  stomach,  the  dose  should  be  very  small  and 
administered  when  the  stomach  is  empty.  If  it  be  desired  to  obtain 
the  full  constitutional  effect,  as  in  combating  malaria  or  an  in- 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


ARSENIC  ,  49 

veterate  neurosis,  it  is  usually  recommended  to  give  the  remedy  after 
meals  and  push  to  full  toleration.  This  is  based  on  the  belief  that 
the  large  dose  unites  with  the  food  and  is  absorbed  in  some  un- 
known, non-irritant  form.  Were  this  true,  it  seems  incumbent  on 
us  to  ascertain  what  this  form  is,  and  to  use  it.  But  the  fact  seems 
to  be,  as  shown  by  Bartholow,  that  even  the  very  small  doses  if 
given  on  an  empty  stomach  produce  constitutional  effects  as  readily 
as  very  large  ones  given  with  the  food.  It  seems  probable  therefore, 
that  most  of  the  dose  taken  after  meals  is  rendered  insoluble,  by 
the  iron  probably,  and  excreted  in  the  feces,  so  that  this  method  of 
dosage  is  uncertain  and  dangerous,  as  one  never  knows  when  con- 
ditions may  arise  in  the  gastro-intestinal  canal  to  render  the  whole 
dose  absorbable,  with  toxic  results.  It  is  much  safer  and  more  -ef- 
fective to  administer  small  doses  before  meals ;  and  if  a  full  phy- 
siologic effect  rapidly  produced  is  desired,  to  give  a  minute  dose 
every  hour  until  the  eyelids  begin  to  itch. 

Murrell  says  that  a  child  five  years  old  will  take  nearly  the  adult 
dose;  and  that  girls  require  larger  doses  of  arsenic  than  boys. 
Bouchet  and  Lewald  found  arsenic  in  a  nursing  mother's  milk. 

Merck's  Index  gives  the  following  data  on  the  various  prepara- 
tions of  arsenic  utilized  in  modern  medical  practice : 

Arsenic  bromide  (tribromide).  Dose  o.ooi — 0.004;  maximum 
o.oi.  Soluble  in  water. 

Arsenic  chloride  (trichloride).  Dose  o.ooi — 0.004.  Soluble  in 
all  proportions  in  alcohol ;  in  ether  and  oils.  Decomposed  by  water, 
with  which  it  is  incompatible. 

Arsenic  iodide  (teriodide).  Dose  o.ooi  to  0.004;  maximum 
single  dose  0.008.  Soluble  in  ether  or  in  carbon  disulphide ;  in 
seven  parts  water  or  thirty  parts  alcohol.  Decomposed  by  water. 

Arsenic  sulphide  (trisulphide).  Soluble  in  alkalies,  their  sul- 
phides or  carbonates. 

Arsenous  acid.  Dose  o.ooi — 0.002 ;  maximum  single  dose  0.005, 
or  o.oi  in  a  day.  Soluble  in  water  very  slightly;  in  alcohol;  freely 
in  hydrochloric  acid. 

Copper  arsenite.  Dose  0.0005  every  half-hour ;  maximum  0.006. 
Soluble  in  alkalies,  slightly  in  water. 

Potassium  arsenate.  Dose  0.003 — 0.006;  maximum  single  dose 
0.006,  or  0.02,  daily.  Soluble  in  water. 

Sodium  arsenate.  Dose  o.ooi — 0.008.  Soluble  in  four  parts 
water,  two  of  glycerin,  or  sixty  of  boiling  alcohol.  This  salt  is  less 
irritant  to  the  stomach  than  most  other  arsenical  preparations. 


50  ASCLEPIDIN 

Iron  arsenate.  Dose  0.004 — 0.008.  Soluble  in  dilute  hydro- 
chloric acid. 

Quinine  arsenate.    Dose  0.004 — 0.008.    Soluble  in  hot  water. 

Caffeine  arsenate.     Soluble  in  hot  water. 

Atfopine  arsenate.  Contains  19.72  per  cent  arsenic  and  80.28 
of  atropine.  Soluble  in  water  and  alcohol. 

Strychnine  arsenate.  Dose  o.ooi — 0.004.  Soluble  in  fourteen 
parts  of  cc*Jd  or  in  five  parts  of  hot  water. 

Antimony  arsenate.    Dose  0.0013. 

Burggraeve  ascribes  a  deobstruent  value  to  antimony  arsenate. 
and  advises  it  in  chronic  pulmonary  affections,  and  in  muscular 
rheumatism. 

The  salient  points  on  which  to  base  the  therapeutic  use  of  arsenic 
are :  first,  its  power  of  stopping  glycogen  formation ;  second,  of 
checking  emaciation  ;  third,  of  causing  gastric  irritation  when  ex- 
hibited in  toxic  doses.  It  is  not  unreasonable  to  attribute  to  small 
doses  a  useful  degree  of  irritation,  with  exaltation  of  function,  cor- 
responding to  that  produced  by  non-toxic  doses  of  all  other  gastric 
irritants. 

The  arsenites  are  preferable  to  the  less  soluble  arsenous  acid  for 
internal  use,  and  their  number,  and  the  combination  with  such  use- 
ful agents  as  strychnine,  iron,  quinine,  caffeine,  copper,  etc.,  give 
an  unusual  opportunity  for  nice  selection. 

The  observation  of  Ringer  as  to  the  curative  power  of  arsenic 
in  the  peculiar  affection  of  the  tongue  he  described,  also  favors  the 
use  of  this  agent  in  gastric  affections,  as  the  diseases  of  the  tongue 
are  so  frequently  dependent  on  disorders  of  the  stomach. 

Finally,  we  cannot  too  strongly  urge  the  necessity  of  distinguish- 
ing between  the  effects  of  large  and  of  small  doses  in  administering 
arsenic.  In  malaria,  where  it  acts  directly  as  a  germicide,  the  full 
quantity  tolerated  is  obviously  required ;  but  in  nearly  all  cases 
where  arsenic  has  won  favor  it  has  been  when  given  in  doses  far  be- 
low the  toxic  point. 

ASCLEPIDIN. 

Standard  granule — Gr.  1-12,  gm.  .005. 

Asclepidin  is  a  concentration  from  the  root  of  Asclepias 
tuberosa. 

The  virtues  depend  on  a  glucoside  obtained  by  Quackenbush  in 
a  crystalline  form.  It  has  not  been  produced  commercially. 

King  says  asclepias  is  diaphoretic,  diuretic,  laxative,  tonic,  car- 


ASCLEPIDIN  51 

initiative,  expectorant  and  probably  antispasmodic.  Being  un- 
stimulating  it  may  be  used  as  a  diaphoretic  in  the  highest  fevers. 
The  secretion  from  the  skin  produced  by  it  closely  resembles  the 
normal  insensible  perspiration.  The  solids  excreted  are  largely 
increased,  rather  than  the  fluid.  Even  when  there  is  a  free  perspira- 
tion asclepias  may  be  needed  to  increase  the  solids  excreted.  It  does 
best  when  the  fever  is  not  too  high,  the  skin  slightly  moist,  the  pulse 
vibratile  and  not  too  rapid.  Aconitine  should  be  added  if  the  pulse 
be  rapid,  weak  and  small ;  veratrine  if  strong  and  bounding. 

Therapeutics. — Asclepidin  increases  the  respiratory  secretions 
and  favors  expectoration.  Its  power  of  naturally  stimulating  the 
skin  renders  it  efficient  in  colliquative  sweating.  It  has  been  termed 
pleurisy  root  from  its  value  in  this  malady,  where  it  may  be  com- 
bined with  bryonin  or  aconitine.  In  pleurodynia,  intercostal  neu- 
ralgia and  rheumatism,  and  in  pericardial  pains  it  is  effective.  Its 
chief  action  being  to  relax  arterial  tension,  it  is  best  suited  to  acute 
attacks.  It  is  a  useful  adjuvant  in  early  pneumonias  and  pleuro- 
pneumonias,  pulmonary  hyperemias  and  extensive  bronchitis,  in  the 
early  and  the  convalescing  stages. 

It  relieves  dry  coughs  if  given  following  lobelin.  It  is  among 
the  best  remedies  for  catarrhs  of  children.  In  phthisis  it  relieves 
the  cough  and  the  mucous  irritability,  It  is  one  of  the  best  remedies 
for  colds,  and  for  all  respiratory  and  gastrointestinal  catarrhs  when 
due  to  recent  colds.  Asclepidin  benefits  gastric  troubles  of  children, 
catarrhal  diarrheas  and  dysenteries,  the  headaches1  of  indigestion, 
flatulent  colics,  dry  skin  diseases,  neuralgias,  rheumatism  with  free 
sweating.  It  favors  the  eruption  in  the  exanthemata,  and  sometimes 
relieves  painful  inflammations  by  the  perspiration  it  induces. 

Scudder  gives  these  specific  indications  for  asclepias :  Pulse 
strong,  vibratile ;  skin  moist ;  pain  acute,  seemingly  dependent  on 
motion.  King  says  the  skin  may  be  hot  and  dry  or  inclined  to 
moisture,  urine  scanty,  face  flushed,  vascular  excitement  marked  in 
parts  supplied  by  bronchial  arterioles,  serous  inflammations,  gastro- 
intestinal catarrhs  caused  by  recent  colds. 

Ellingwood  says  asclepias  is  specific  for  pleuritic  pains,  facilitat- 
ing the  rapid  removal  of  the  effusion.  For  stomach  pains  it  should 
be  given  in  full  and  continued  doses.  It  soothes  the  entire  intestinal 
mucosa. 

For  acute  maladies  asclepidin  may  be  given  in  doses  of  gr.  1-12 
to  1-4  in  a  cup  of  hot  water,  repeated  every  half-hour  till  effect.  In 
chronic  maladies  the  dose  is  a  grain  before  meals  and  at  bedtime. 


52  ASPARAGIN 

ASPARAGIN. 

Standard  granule — Gr.  1-67,  gm.  .001. 

Asparagin  is  a  glucoside  found  in  many  plants,  but  in  greatest 
quantity  in  the  vegetable  asparagus.  The  well-known  odor  im- 
parted to  the  urine  by  eating  asparagus  is  not  due  to  this  principle, 
however,  but  to  methylmercaptan.  To  this  odor  is  possibly  due  the 
repute  asparagin  holds  as  a  diuretic,  a  doubtful  matter,  as  neither 
Falck,  Jacobi  nor  Posner  obtained  any  diuresis  from  doses  up  to 
fifteen  grains.  Nor  was  the  pulse  notably  affected.  Huesemann 
also  failed  to  obtain  any  useful  effect  in  dropsies  dependent  on  heart 
disease. 

But  there  are  other  functions  of  the  human  body  besides  the 
few  that  have  been  selected  as  tests  of  remedies.  In  the  plant  world 
asparagin  fills  a  place  analogous  to  that  of  urea  and  uric  acid  in  the 
animal,  as  one  of  the  principal  products  of  albuminoid  decomposi- 
tion. But  while  urea  and  uric  acid  become  useless  to  the  animal 
and  must  be  eliminated  from  the  body,  asparagin,  produced  by  the 
destruction  of  a  molecule  of  albumin,  can  be  immediately  utilized  in 
the  green  plant,  and  serves  to  build  a  new  molecule  of  albumin.  In 
the  legumes  asparagin,  formed  and  accumulated  at  the  moment  of 
germination  and  produced  by  the  destruction  of  the  reserve  of 
albuminoids  utilized  during  germination,  disappears  subsequently 
when  the  young  plants  become  charged  with  chlorophyll.  Thus  the 
disappearance  of  asparagin  coincides  with  the  formation  of  an 
equivalent  quantity  of  a  new  albumin. 

Therapeutics. — It  is  likely  that  asparagin  increases  the  excretion 
of  solid  matters  by  the  kidneys,  since  it  has  won  some  repute  as  a 
remedy  for  gout,  milder  than  colchicine.  As  long  as  all  diuretics  are 
judged  by  their  power  of  reducing  dropsical  effusions,  there  is  little 
chance  of  estimating  the  true  value  of  such  remedies. 

Asparagus  has  been  accredited  with  aphrodisiac  and  emmenagog 
properties.  It  sometimes'  causes  a  urethral  discharge  like  that  of 
gonorrhea,  and  its  use  may  increase  the  irritation  of  that  malady.  It 
has  been  used  in  place  of  ergot  to  stimulate  uterine  contractions  after 
miscarriage  or  in  the  later  stages  of  labor.  Sometimes  it  causes 
serious  disturbance  of  the  renal  function.  Its  use  has  been  pro- 
posed as  a  means  of  testing  the  permeability  of  the  kidneys :  If  the 
characteristic  odor  of  the  urine  does  not  follow  the  eating  of 
asparagus  any  remedy  excreted  by  the  kidneys  is  apt  to  accumulate 
in  the  body  and  cause  poisoning. 


ASPIDOSPERMINE  53 

Dr.  E.  A.  Welch,  of  Sutton,  Mass.,  reported  two  cases  of 
cystitis  in  which  he  found  benefit  from  asparagin.  Several 
others  have  reported  this  agent  as  giving  a  more  pronounced  diuretic 
action  than  the  foregoing  account  would  indicate. 

ASPIDOSPERMINE. 

Standard  granule — Gr.   1-67,  gm.  .001. 

Some  years  ago  the  medical  profession  welcomed  a  new  ap- 
plicant for  favor,  in  the  form  of  quebracho,  an  extract  from  the  bark 
of  an  evergreen  tree  of  South  America.  It  was  presented  as  a 
specific  remedy  for  the  symptom  of  dyspnea,  occurring  in  the  course 
of  any  malady.  Investigation  showed  that  this  extract  contains  at 
least  six  alkaloids,  whose  properties  differ  to  some  extent,  though, 
as  in  the  case  of  the  digitalis  glucosides,  there  is  a  strong  similarity 
in  their  action. 

Harnack  and  Hoffman  found  that  aspidospermatine  causes  in  the 
frog  paralysis  of  respiration  and  of  all  striated  muscle,  including 
the  heart.  In  mammals  the  most  marked  action  is  on  the  respira- 
tion. 

Quebrachine  exerts  a  precisely  similar  action  on  the  frog,  but  is 
twenty  times  stronger  in  mammals,  causing  death  by  respiratory 
paralysis. 

Quebrachamine  closely  resembles  aspidospermine. 

Aspidosamine  closely  resembles  aspidospermatine  on  the  respira- 
tion and  muscle  fiber,  but  also  paralyses  the  motor  nerve-ends. 

Aspidospermine  was  discovered  by  Hesse.  It  is  soluble  in  al- 
cohol, in  106  parts  of  absolute  or  48  parts  of  90  per  cent  ether,  6,000 
of  water,  and  easily  in  benzoin  or  chloroform.  The  salts  are  very 
soluble.  It  is  very  bitter.  It  forms  colorless,  hard  prisms,  or  fine 
acictilar  crystals.  Potassium  iodide,  Mayer's  reagent,  potassium- 
bismuth  iodide,  bromine,  and  phosphomolybdenic  acid,  give  white 
precipitates  with  very  dilute  solutions ;  picric  acid  with  a  solution 
i-iooo;  but  tannic  acid  only  in  concentrated  solution.  Concentrated 
sulphuric  acid  and  Froehde's  reagent  dissolve  aspidospermine  with- 
out coloring.  In  diluted  perchloric  acid  it  dissolves  on  heating,  with 
red  color. 

Physiologic  Action. — Small  doses  by  stimulative  centric  action 
make  the  breathing  more  rapid  and  deeper,  slow  the  heart  and  lower 
temperature.  Large  doses  cause  tonic  contractions  and  con- 
vulsions. Lethal  doses  render  respiration  slow,  weak  and  arrhyth- 


.U  ASPIDOSPERMINE 

mic,  death  coming  from  apnea.  The  heart  continues  to  contract 
after  the  breathing  ceases.  The  effect  is  especially  on  the  medullary 
centers,  as  shown  by  nausea  and  respiratory  changes ;  and  on  the 
spinal  cord,  as  indicated  by  the  convulsions,  and  increased  reflex 
excitability.  The  muscular  fibers'  are  weakened  and  finally  paralyzed 
in  the  frog,  but  not  in  mammals.  The  circulation  is  weakened  by 
the  nausea,  and  directly  by  lethal  doses  (Cushny).  Eloy  and 
Huchard  noticed  diarrhea  and  diuresis  occurring  sometimes,  and  a 
diminution  of  the  hemoglobin.  The  venous  blood  of  animals  after 
toxic  doses  is  red,  like  that  of  animals  killed  by  bulbar  puncture. 
Penzoldt  explained  this  by  attributing  to  aspidospermine  the  power 
of  increasing  in  the  red  blood  cells  the  capacity  of  absorbing  oxygen, 
and  depriving  them  of  the  power  of  parting  with  it  to  the  tissues. 

While  this  alkaloid  causes  nausea  in  overdoses  it  does  not  oc- 
casion vomiting,  even  in  excessive  doses.  It  increases  the  mucous 
secretion  of  all  the  respiratory  tract,  and  also  the  saliva. 

Quebrachine  has  the  formula  C^H-jeNoOg.  It  forms  delicate 
acicular  crystals,  intensely  bitter  in  solutions,  almost  wholly  in- 
soluble in  cold  water  or  alcohol,  alkalies  or  ether,  and  easily  in  chlo- 
roform and  in  boiling  alcohol.  It  is  dextro-gyrate.  It  gives  no 
color  with  iron  chloride.  Boiled  in  perchloric  acid  it  becomes  yel- 
low. A  solution  in  concentrated  sulphuric  acid  becomes'  bluish  in  a 
few  minutes ;  adding  potassium  bichromate  it  becomes  blue,  and 
finally  reddish  brown. 

Quebrachine  is  a  powerful  respiration  paralyzer;  0.005  (ST- 
1-12)  injected  intravenously  kills  a  rabbit  instantly  by  respiratory 
paralysis.  In  mammals  the  paralysis  is  preceded  by  a  brief  period 
of  increased  irritability,  the  rate  and  depth  of  respiration  being  in- 
creased, and  muscular  spasms  following.  In  frogs  it  paralyzes  the 
motor  apparatus,  first  affecting  the  peripheral  respiratory  nerves, 
whereas  the  other  quebracho  alkaloids  affect  the  centers  (Liebreich). 
The  pulse  is  slowed  to  stopping,  but  only  after  respiration  ceases. 
In  toxic  doses  the  breathing  deepens,  the  rate  of  respiration  being 
unaltered ;  the  quantity  of  air  inhaled  is  greater,  but  the  excretion  of 
carbonic  acid  gas  does  not  correspond.  The  blood  absorbs  and  re- 
tains more  oxygen  (Penzoldt),  the  medulla  lacks  oxygen,  and 
dyspnea  results. 

Quebrachine  also  lowers  the  temperature,  even  small  doses 
causing  a  fall  of  12  to  14  degrees  F.  in  ten  minutes  (Eloy  and 
Huchard)  ;  at  the  same  time  increasing  the  secretion  of  urine. 

Schiffer  found  that  an  extract  of  quebracho  bark  caused  in  a 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


ASPIDOSPERMINE  55 

mammal  (rabbit)  muscular  weakness,  followed  by  paralysis,  with 
greatly  diminished  reflex  excitability,  the  deepest  narcosis,  with 
rapid  breathing,  the  heart  and  pupils  unaffected.  Death  was  pre- 
ceded by  convulsions'.  The  motor  nerve-trunks  even  before  death 
were  almost  devoid  of  functional  activity. 

Eloy  and  Huchard  found  that  after  removing  quebrachine,  hypo- 
quebrachine.  aspidospermine  and  aspidospermatine,  the  residuum 
had  some  effect  on  the  sensibility,  although  the  four  bodies  removed 
had  none,  but  produced  tonic  convulsions  and  reduced  the  tempera- 
ture. Aspidospermine  greatly  excelled  the  other  alkaloids  as  to  the 
effect  on  respiration. 

We  see  therefore  that  the  physician  who  prescribes  the  extract 
of  quebracho  has  at  his  command  an  agent  of  undoubted  power. 
It  may,  if  aspidospermatine  be  predominant,  cause  respiratory  seda- 
tion and  muscular  debility  to  a  certain. extent ;  if  quebrachine  be  the 
predominant  alkaloid  he  will  get  twenty  times  the  same  effect.  If 
aspidosamine  be  the  principal  alkaloid  in  the  sample  he  secures,  he 
will  have  in  addition  to  cope  with  paralysis  of  the  peripheral  termini 
of  the  motor  nerves.  Should  he  be  fortunate  enough  to  secure  a 
preparation  in  which  all  the  foregoing  exist  in  small  amount,  but 
aspidospermine  is  richly  present,  he  will  obtain  the  respiratory 
stimulation  he  seeks,  with  lowered  temperature  and  slower  pulse, 
without  any  weakening  of  the  heart.  He  may  find  the  reflex  ex- 
citability lowered  or  heightened,  as  the  case  may  be.  Possibly  the 
bowels'  will  be  loosened  or  the  urine  increased  in  quantity,  but  then 
again  nothing  of  the  sort  may  occur.  Maybe  it  will  induce  profound 
narcosis,  or  drop  the  temperature  i  to  4  degrees,  or  affect  the  sensory 
nerves.  In  short,  there  is  a  terrifying  uncertainty  as  to  what  effects 
are  going  to  follow  the  administration  of  quebracho,  that  is  cal- 
culated to  keep  the  physician  guessing.  Probably  his  best  plan  after 
prescribing  it  is  to  sit  on  the  fence  until  summoned,  with  stomach- 
pump  in  hand. 

The  effects  of  aspidospermine  are  distinct,  uniform  and  unvary- 
ing :  their  quality  and  degree  of  action  can  be  calculated  to  a  nicety 
— the  effect  is  certain  when  the  indication  is  presented. 

Therapeutics. — Aspidospermine  has  been  employed  for  the  relief 
of  dyspnea,  as  occurring  in  the  course  of  asthma,  emphysema  and 
other  respiratory  maladies.  It  is  less  effective  in  the  dyspnea  of  pul- 
monary tuberculosis.  Harnack  asserts,  however,  that  the  best 
quebracho  alkaloid  for  this  purpose  is  quebrachine. 

Eloy  and  Huchard  recommend  aspidospermine  as  an  antipyretic 


56  ASPIDOSPERMINE 

in  fevers.  Fronde  gave  it  in  typhoid  fever  to  lower  the  temperature 
and  stimulate  the  lungs.  It  has  proved  of  service  in  every  form  of 
dyspnea,  bronchial,  cardiac,  nervous,  even  in  that  of  uremic  origin 
(Wood),  as  well  as  in  emphysema  and  in  spasmodic  croup. 

Picot  states  that  taken  before  hill-climbing,  it  increases  the 
respiratory  endurance. 

Its  effect  in  relieving  cyanosis  is  marked  (Shoemaker).  In  a 
child  with  double  pneumonia,  it  decidedly  improved  the  breathing 
and  the  heart-action  (Lawrence). 

In  acute  rheumatism  and  in  serous  inflammations,  it  sedates  the 
pulse  and  lowers  the  fever  (Shoemaker). 

Dosage. — The  dose  is  somewhat  doubtful,  and  Penzoldt  says  that 
it  must  be  separately  ascertained  for  every  case.  As  0.003  (Sr- 
1-22),  hypodermically,  causes  muscular  tremor,  it  is  best  to  begin 
with  doses  of  0.0005  (gr.  1-134)  repeated  every  hour  or  oftener  till 
the  desired  effect  has  been  obtained.  The  dose  thus  ascertained  may 
be  given  subsequently  at  once. 

For  hypodermic  use  the  chloride  is  suited  by  its  ready  solubility 
in  water.  Dose  0.0005  (gr-  I"I34)>  not  exceeding  0.002  (gr.  1-33). 

Or  for  hypodermic  use  dissolve  0.2  of  aspidospermine  in  water 
10.0  with  the  aid  of  a  trace  of  sulphuric  acid,  neutralizing  if  neces- 
sary with  sodium  bicarbonate  (Bocquillon-Limousin).  The  doses 
given  for  the  commercial  aspidospermine  cannot  be  taken  as  apply- 
ing to  the  pure  product  now  employed  under  that  name. 

Quebrachine  hydrochlorate  dissolves  easily  in  hot  water  and  re- 
mains in  solution  on  cooling.  The  average  dose  is  0.005 — °-1  (Sr- 
1-12 — I  1-2)  three  times  daily;  or  better,  o.ooi  (gr.  1-67)  even- 
hour  or  oftener  until  the  desired  effect  is  obtained.  It  is  of  use  in 
asthma,  emphysema,  bronchitis  with  marked  nervous  irritability  and 
dyspnea,  and  may  be  used  in  affections  characterized  by  hyper- 
pyrexia. 

If  the  physician  is  not  going  to  delve  deeply  into  the  active 
principles  of  quebracho  he  had  best  content  himself  with  two  things, 
and  should  so  fix  them  in  his  mind  that  they  will  stick  forever.  ( i ) 
Never  use  the  extract  under  any  circumstances  if  the  alkaloids  are 
attainable.  (2)  Always  use  aspidospermine  to  the  exclusion  of  the 
others  and  learn  how  to  use  it  right,  remembering  that  it  relaxes 
spasm,  stimulates  the  breathing  mechanism  and  slows  and  steadies 
the  heart,  effects  desired  in  all  cases  of  dyspnea;  therefore  the  in- 
dication. Give  aspidospermine  in  dyspnea ;  give  it  right  and  you 
will  not  be  disappointed. 


ATROPINE  57 

ATROPINE. 

Standard  granules — Atropine  sulph.,  gr.  1-500,  gm.  .000125;  atropine 
sulph.,  gr.  1-250,  gm.  .00025;  atropine  valerianate,  gr.  1-250,  gm.  .00025. 

Of  all  the  remarkable  agents  in  the  wonderful  alkalometric 
armamentarium,  none  is  of  greater  interest  than  atropine.  The  more 
the  science  of  drug-action  is  studied  the  greater  is  the  tendency  to 
lift  this  powerful  alkaloid  into  the  place  heretofore  occupied  by  mor- 
phine, a  monarch  who  has  forfeited  his  crown  by  bad  behavior. 

The  group  of  plants  containing  atropine  has  been  from  the 
earliest  days  of  the  medical  art  recognized  as  possessed  of  powerful 
influences,  for  good  or  evil,  over  the  human  body.  As  poisons  the 
names  of  deadly  night-shade,  henbane  and  death-apple  represent  the 
popular  idea  of  belladonna,  hyoscyamus  and  stramonium  re- 
spectively. 

In  medical  practice  they  were  recommended  for  about  every- 
thing in  the  list,  especially  for  maladies  not  readily  controlled  by 
ordinary  agents;  but  the  general  repute  of  the  whole  group  was — 
unquestioned  power  but  uncertainty  of  action,  and  therefore  unre- 
liability. They  were  remedies  "to  be  tried,"  and  that  this  uncer- 
tainty should  exist  in  the  case  of  these  ancient  remedies,  after  thou- 
sands of  years'  use,  shows  well  the  true  status  of  the  science  of 
therapeutics  in  this,  the  twentieth  century  of  Christianity ;  though 
in  truth  the  use  of  these  drugs  antedated  the  present  era  by  at  least 
twenty  centuries  more. 

We  now  know  that  the  cause  of  this  uncertainty  lay  in  the  vary- 
ing chemical  composition  of  the  plants.  Nature  is  unvarying  and  in 
her  is  no  shadow  of  uncertainty :  and  the  same  conditions  of  sun- 
shine, heat  and  moisture  accomplish  the  same  results,  with  of  course 
the  other  influences  of  soil,  competition,  etc.  And  as  these  condi- 
tions vary  she  produces  varying  proportions  of  atropine  in  each  of 
these  plants,  and  varying  proportions  of  certain  other  alkaloids  as 
well.  She  leaves  to  the  enlightened  reason  of  man  the  task  of 
separating  these  principles  and  utilizing  their  properties. 

Belladonna  contains  atropine  with  hyoscine,  hyoscyamine,  atro- 
pamine,  and  belladonnine.  Atropine  predominates. 

Hvoscyamus  contains  hyoscyamine  and  hyoscine,  with  a  little 
atropine.  Either  may  predominate. 

Stramonium  contains  atropine,  hyoscyamine  and  hyoscine. 

Duboisia  myoporoides  contains  hyoscine  or  hyoscyamine  and 
other  alkaloids.  Another  duboisia  contains  piturine.  closely  allied 
to  nicotine. 


58  ATROPINE 

Scopolia  contains  hyoscyamine,  hyoscine  and  a  little  atropine. 

Mandragora  probably  contains  a  mixture  of  these  alkaloids. 

The  leaves  of  tobacco  and  potato  contain  some  of  these  alka- 
loids. Decomposing-  fish  and  meat  contain  a  ptomaine,  ptomatropine, 
whose  effects  closely  resemble  those  of  atropine. 

Not  one  of  these  sources  supplies  any  one  of  these  alkaloids 
without  the  other,  or  in  unvarying  proportions.  Belladonna  comes 
nearest  to  giving  a  uniform  effect,  the  atropine  nearly  always  pre- 
dominating. 

These  agents  affect  man  and  the  dog  easily,  while  other  animals 
feed  upon  the  plants  containing  them  with  impunity. 

Atropine  was  isolated  in  1833  by  Geiger  and  Hesse,  but  Mein 
had  already  discovered  it  in  1831.  It  crystallizes  in  prismatic  nee- 
dles. It  is  soluble  in  300  parts  of  cold  water  or  in  58  parts  boiling 
water,  very  soluble  in  alcohol,  and  this  solution  is  very  easily  pre- 
cipitated by  a  very  little  water.  It  is  soluble  in  35  parts  cold  ether, 
6  of  boiling  ether,  3  parts  chloroform  and  very  easily  in  amylic 
alcohol.  The  salts  crystallize  with  difficulty,  and  are  readily  solu- 
ble in  water  or  alcohol,  very  slightly  in  ether. 

Physiologic  Action. — Van  Renterghem  gives  the  following  symp- 
toms, as  they  appear  successively  after  taking  atropine :  Dryness  of 
mouth  and  throat,  thirst,  disordered  vision,  paralysis  of  accommoda- 
tion, alteration  of  the  voice,  aphonia,  sense  of  cold  followed  by  rapid 
pulse,  redness  of  the  face,  vertigo,  headache,  and  delirium.  If  the 
alkaloid  be  then  discontinued,  the  symptoms  subside  in  reverse  order 
in  12  hours,  except  the  ocular,  which  may  last  longer.  Very  large 
doses  cause  the  same  symptoms  but  more  accentuated,  the  stage  of 
excitement  short  and  quickly  followed  by  that  of  paralysis;  degluti- 
tion impossible,  dysphagia,  rabic  symptoms,  injected  conjunctive, 
eyes  prominent,  face  crimson,  iris  disappeared,  furious  delirium,  end- 
ing in  complete  adynamia,  fall  of  pulse,  which  had  reached  150, 
lessened  heat,  respiration  difficult,  cutaneous  anesthesia,  paresis, 
soporous  state,  convulsions  general  and  partial,  retention  and  then 
incontinence  of  urine  and  feces,  weakening  and  irregularity  of  the 
pulse,  and  death  by  asphyxia  in  3  to  36  hours. 

The  muscular  motor  nerve-ends  are  paralyzed  by  large  doses ; 
as  well  as  the  cutaneous  sensory  nerve-ends,  hypodermic  injections 
producing  more  local  anesthesia  than  morphine.  Gubler  mentions  a 
case  where  the  patient  after  a  full  dose  was  unable  to  button  his* 
clothes,  the  tactile  sense  being  abolished  and  the  muscles  having  lost 
their  power. 


ATROPINE  59 

While  small  doses  paralyze  the  intracardiac  vagus  ends,  permit- 
ting an  enormous  rise  of  the  pulse-rate,  it  is  evident  that  other  por- 
tions of  the  heart  are  influenced  by  atropine,  since  it  lifts  the 
paralysis  caused  by  chloroform,  potash  salts,  oxalates,  cholates,  apo- 
morphine,  copper,  zinc,  antimony  or  quinine  (Luchsinger). 

Atropine  stops  the  action  of  glands  by  a  direct  influence  over  the 
secretory  nerve  fibers,  the  vasomotor  influence  going  for  nothing. 

It  arrests  the  peristaltic  movements  of  the  intestine  completely 
when  they  depend  only  on  the  motor  nerve-centers  (Schmiedeberg). 
The  paralyzant  action  is  best  shown  when  the  circular  fibers  are  in 
spasmodic  contraction.  This  action  is  exerted  on  the  stomach, 
spleen,  bladder,  uterus,  bronchi,  etc. 

Small  doses  lessen  the  excitability  of  the  ganglionic  system  of 
the  intestine,  bladder,  ureters,  uterus,  perhaps  paralyzing  the 
smooth  muscular  fibers  themselves  (Bezold  and  Bloebaum). 

The  scarlatiniform  redness  of  the  face  and  upper  part  of  the 
body  may  depend  on  the  local  vasodilation,  or  rather  on  the  rapid 
pulse  and  rise  of  blood-pressure  (Van  Renterghem). 

The  influence  of  atropine  on  the  vasomotor  nerves  explains  its 
antiphlogistic  effect.  Zeller  observed  that  a  solution  of  atropine  sul- 
phate in  a  neutral  solution  of  sodium  chloride  dilated  trfe  arteries, 
accelerating  the  circulation  in  veins  and  capillaries  not  dilated.  The 
passage  of  white  globules  into  the  tissues  was  checked,  the  amoeboid 
movement  of  emigrated  cells  was  lost  on  contact  with  atropine,  and 
they  became  round  and  opaque. 

Atropine  exerts  its  effects  markedly  on  the  peripheral  nerve-ends, 
paralyzing  the  pupil  contractors  and  accommodation  apparatus  of 
the  eye,  the  cardiac  inhibitory  centers  connected  with  the  vagus,  the 
intestinal  and  other  unstriped  muscular  fiber,  and  the  secretory  nerves 
of  many  glands.  Large  doses  affect  the  cerebrum  causing  delirium. 

The  conjunctiva  is  most  sensitive  to  atropine,  which  diffuses  it- 
self into  the  ocular  tissues  without  entering  the  blood,  as  one  pupil, 
or  even  a  part  of  one  pupil,  may  be  fully  dilated  without  affecting 
the  other  pupil  or  the  rest  of  that  one.  The  drug  affects  the  ends  of 
the  oculo-motor  fibers  in  the  muscle-cells  of  the  sphincter.  If  thor- 
oughly atropinized  no  direct  irritation  of  the  oculo-motor  in  the 
cranium  will  affect  the  pupil ;  though  if  the  patient  be  insulated  and 
a  static  current  applied  to  any  part  of  the  body  the  iris  will  contract 
(Neiswanger).  In  birds  the  iris  consists  of  striated  muscle  fiber, 
and  this  is  not  affected  by  atropine.  To  paralyze  the  accommoda- 
tion requires  larger  doses  and  longer  time. 


60  ATROPINE 

Atropine  lessens  the  number  of  the  leucocytes,  and  the  excretion 
of  uric  acid  (Horbaczewski). 

When  atropine  is  given  internally,  in  doses  of  o.ooi  (gr.  1-67) 
thrice  daily,  it  affects  the  eye,  the  glandular  innervation  and  the 
motion  of  organs  containing  unstriped  muscle-fiber,  including  the 
heart.  In  moderate  doses  atropine  abolishes  the  action  of  the  chorda 
tympani  on  the  salivary  secretion,  but  not  the  influence  of  this  nerve 
over  the  dilation  of  blood-vessels,  nor  the  function  of  the  gland-cells. 
For  irritation  of  the  sympathetic  has  the  same  effect  after  the 
atropine  intoxication  as  before  it,  the  gland-cells  secreting  thick  and 
scanty  saliva  (Heidenhain).  Physostigmine  in  large  doses,  injected 
into  the  artery  of  the  gland  or  its  parenchyma,  overcomes  this 
paralysis,  unless  the  dose  of  atropine  is  overwhelming,  and  active  in 
the  general  circulation.  All  the  salivary  glands  are  affected  alike  by 
atropine.  Minute  doses  stop  the  secretion  of  the  mucous  glands  of 
the  tongue,  controlled  by  the  glosso-pharyngeal.  The  lessened  sense 
of  smell  is  due  to  the  drying  up  of  the  nasal  mucus-secretion. 

On  the  glands  of  the  digestive  apparatus  atropine  acts  less 
energetically.  The  secretion  of  pepsin  and  hydrochloric  acid  is 
checked.  e  The  pancreatic  secretion  is  checked,  and  simul- 
taneously the  passage  of  substances  from  the  stomach  into 
the  duodenum  completely  prevented  (Pawlow).  Irritation 
of  the  vagus  excites  pancreatic  secretion,  limited  but  not  entirely 
stopped  by  atropine  (Pawlow).  The  increase  of  pancreatic  secretion 
by  muscarine  is  completely  suppressed  by  atropine,  but  the  stimula- 
tion of  bile-secretion  by  muscarine  is  only  lessened  by  atropine.  This 
would  indicate  the  value  of  atropine  as  a  remedy  for  hyperchlor- 
hydria. 

The  amount  of  urine  and  of  urea  i&  lessened  by  intravenous 
doses  of  atropine,  0.0015 — 0.002  (gr.  1-43 — 1-33)  per  kilo  of  body- 
weight.  This  decrease  is  prevented  by  free  ingestion  of  water,  salt 
and  urea. 

On  the  perspiration  the  effect  of  atropine  is  strictly  analogous 
to  that  on  the  sweat-glands.  Reflex  and  direct  irritation  of  the 
secretory  nerves  are  alike  useless,  even  after  small  doses*  of  atro- 
pine (Luchsinger).  Pilocarpine  or  physostigmine  applied  locally 
restores  the  secretion  and  the  irritability  of  the  centrifugal  secretory 
nerves. 

It  is  less  certain  that  atropine  directly  lessens  the  secretion  of 
milk  and  of  the  respiratory  mucosa.  The  action  of  this  agent  on  the 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


ATROPINE  61 

blood-vessels  may  account  for  the  clinical  observations  made  in  this 
respect,  which  certainly  show  a  decrease  in  the  secretion. 

The  nerve-ends  in  unstriped  muscle-fiber  are  paralyzed  by 
atropine,  as  those  of  striated  fiber  are  by  carmine.  When  under  the 
toxic  influence  of  atropine,  irritation  of  the  vagus  will  not  produce 
gastric  or  intestinal  motion.  Small  doses  of  atropine  stop  peristalsis, 
while  large  doses  directly  irritate  the  intestinal  musculature,  and 
even  with  small  doses  the  previously  quiet  intestine  will  begin 
peristalsis  (Liebreich).  But  exceedingly  small  doses  by  paralyzing 
inhibition  facilitate  the  movement  of  the  bowels  (Brunton). 

The  paralysant  dose  of  atropine  varies  with  different  organs.  The 
bladder  retains  irritability  when  the  cesophagus  is  paralyzed. 

Atropine  acts  on  the  circular  muscle-fibers  of  the  arteries  locally 
and  from  the  vasomotor  centers.  Added  to  the  blood  supplied  an 
exsected  living  organ,  the  current  is  slowed  briefly  and  then  much 
accelerated,  showing  the  relaxation  of  the  circular  arterial  muscles. 
By  exciting  the  vasomotor  center  the  vascular  tension  is  raised.  In 
dogs,  after  large  doses,  o.oi  per  kilo,  the  cutaneous  vessels  dilated 
while  the  cerebral  vessels  contracted,  and  the  arterial  tension  was 
raised  (Albertini).  This  central  effect  is  transmitted  mainly  by  the 
cervical  sympathetic,  and  when  this  is  severed  neither  dilation  nor 
contraction  occurs. 

On  the  heart  even  small  doses  paralyze  inhibition,  the  pulse-rate 
in  man  increasing.  No  amount  of  irritation  of  the  vagus  will  slow 
the  pulse  or  stop  the  heart  under  atropine.  So  also  dyspnea  and  ir- 
ritability lose  their  effect  on  the  heart.  For  some  unknown  reason 
the  heart  first  slows  when  a  toxic  dose — 0.005  (sr-  1-12) — of  atro- 
pine is  taken.  Yet  the  slow  pulse  of  muscarine,  which  stops  the  heart 
in  diastole,  is  promptly  quickened  by  atropine ;  while  muscarine  is 
unable,  in  any  dose,  to  antidote  the  effects  of  atropine.  Large  doses 
of  the  latter  directly  paralyze  the  muscular  fibers  of  the  heart. 

On  .the  respiration  atropine  acts  by  paralyzing  the  vagus  ends, 
and  slows  the  breathing.  But  by  its  action  on  the  respiratory  center 
it  prolongs  and  deepens  the  respirations. 

On  the  brain  atropine  acts  as  an  irritant,  in  large  doses  causing 
excitement,  unrest,  insomnia,  haste  in  movements  and  combative- 
ness.  In  full  intoxicant  doses  it  causes  hallucinations  of  sight  and 
hearing,  delirium  mostly  cheerful,  erotism,  impulse  to  constant 
activity,  eventuating  in  convulsions ;  followed  by  paretic  symptoms, 
syncope,  anesthesia,  sopor.  Very  large  doses  finally  paralyze 
striated  muscle,  like  curarine. 


62  ATROPINE 

Some  tolerance  of  atropine  may  be  acquired,  but  cumulative  ef- 
fects may  occur  ending  in  death. 

Atropine  often  causes  a  rise  in  temperature,  independent  of  the 
convulsions  and  circulatory  changes.  The  heat  radiation  is  in- 
creased but  the  heat-formation  still  more.  This  is  due  to  a  direct 
action  on  the  cerebral  heat-center  (Ott). 

Synergists. — The  mydriatic  group,  belladonnine,  homatropine, 
duboisine,  daturine,  hyoscyamine,  mandragorine,  all  probably  forms 
or  compounds  of  atropine.  Among  auxiliaries  are  hydrocyanic  acid, 
a  mydriatic,  analgesic  and  cough  sedative ;  quinine  as  an  anti- 
phlogistic ;  cicutine  as  a  paralyzant  of  motor  nerve-ends,  analgesic 
and  mydriatic ;  morphine,  although  it  contracts  the  pupil  and  con- 
gests the  brain,  suspends  bronchial  and  intestinal  secretion  and 
calms  pain ;  strychnine  raises  the  general  tonicity  and  augments  the 
debilitatcxl  contractility  of  the  longitudinal  muscular  fibers  in  cases 
of  mixed  paresis  and  spasm,  often  present  in  asthma,  dysuria,  reten- 
tion of  feces ;  camphor  monobromide  as  antispasmodic  and  sexual 
sedative,  in  the  latter  adding  gelsemin  and  cypripedin ;  quinine  and 
ergotin  in  combating  hyperemia  and  as  oxytocics ;  camphor,  capsi- 
cum and  glonoin  in  forcing  out  retarded  eruptions. 

Antagonists. — Nicotine  is  held  by  some  to  be  synergist,  but 
seems  rather  an  antagonist,  as  it  contracts  the  pupil,  and  augments 
all  the  secretions,  especially  the  sweat  and  saliva. 

Muscarine  excites  the  parts  of  the  peripheral  organs  paralyzed 
by  atropine,  slows  pulse,  lowers  arterial  pressure,  increases  saliva, 
tears,  sweat,  mucous  secretions,  bile,  pancreatic  juice,  causes  con- 
traction of  the  pupil  and  spasm  of  accommodation,  tetanic  contrac- 
tion of  stomach  and  intestines,  of  bladder,  spleen  and  uterus. 

Pilocarpine  and  nicotine  possess  properties  analogous  to  those  of 
muscarine.  The  excitation  of  the  peripheric  terminations  of  the  in- 
hibitory nerve  of  the  heart  produced  by  these  alkaloids  is  soon  fol- 
lowed by  paralysis,  as  the  primitive  myosis  is  succeeded  by  a  light 
mydriasis.  Both  augment  glandular  secretion  and  excite  contrac- 
tions of  the  stomach  and  intestines.  Atropine  prevents  or  sedates 
these  symptoms. 

By  its  special  action  on  the  secretion  of  the  bronchial  mucous 
glands  apomorphine  is  the  antipode  of  atropine.  But  nevertheless 
we  can  serve  ourselves  with  both  at  once,  the  apomorphine  to  dimin- 
ish the  viscosity  of  the  bronchial  mucus,  the  atropine  to  relax  spasm. 

Physostigmine,  which  exciter  the  muscular  system  of  the  life 
of  relation  as  well  as  that  of  nutrition,  and  tends  to  paralyze  the 


ATROPINE  63 

whole  central  nervous  system,  is  but  illusory  as  an  antagonist.  Ex- 
perimenting on  a  cat,  by  giving  successively  muscarine,  atropine  and 
physostigmine,  we  can  cause  spasm  of  the  intestine,  then  complete 
detention,  and  again  spasm ;  myosis  and  accommodation  spasm, 
then  pupil-dilatation  and  accommodation-paralysis,  finally  again 
pupillary  contraction ;  the  salivation  caused  by  muscarine  is  arrested 
by  atropine  and  restored  by  physostigmine.  Probably  physostigmine 
excites  the  muscular  fiber  and  gland  tissue  thereby  masking  or 
neutralizing  the  paralysis  of  the  peripheric  nerve-ends  produced  by 
atropine. 

Gelsemin,  cicutine  and  the  bromides  combat  the  cerebral  hy- 
peremia  of  atropine. 

An  exact  antagonism  of  medicinal  agents  is  unknown.  One 
modifies  the  apparent  effect  of  another  by  acting  on  some  other  part 
of  the  bodily  mechanism. 

Atropine  is  an  effective  remedy  in  poisoning  from  the  fly  fungus, 
Amanita  muscaria,  or  its  alkaloid  muscarine  (Schmiedeberg).  In 
nicotine  poisoning  the  stage  of  irritation  is  combated  by  atropine, 
but  the  sudden  reversion  to  paralysis  nearly  related  to  that  of  atro- 
pine, suggests  caution  (Robert).  More  important  is  its  antagonism 
to  morphine.  The  lowering  of  vascular  tension  and  slowing  of 
respiration  caused  by  morphine  are  directly  antagonized  by  atropine. 
Failure  may  be  ascribed  to  overdosing  with  atropine,  its  paralytic 
effects  becoming  manifest.  P.ut  morphine  is  far  from  being  a 
counter-poison  to  atropine. 

Children  bear  atropine  much  better  than  adults.  Flaxen  blonds 
are  extraordinarily  liable  to  its  action,  even  in  the  smallest  doses. 
Inebriates  are  apt  to  become  wildly  delirious  from  ordinary  med- 
icinal doses,  of  0.0005  (Sr-  I~I34)-  Idiosyncrasies  are  common. 
This  remedy  should  therefore  be  given  in  very  small  doses,  repeated 
quickly  till  the  desired  effect  is  manifest. 

Therapeutics. — As  a  mydriatic  atropine  has  become  indispensa- 
ble to  the  oculist,  from  the  uniformity,  certainty  and  power  of  its 
effects.  A  solution  of  0.06  (gr.  j)  to  8.0  (two  drams)  of  distilled 
water  is  usually  prescribed,  five  drops  being  applied  to  the  lower 
conjunctival  fold  every  four  hours  for  two  days.  This  fully  dilates 
the  pupil  and  paralyzes  the  accommodation. 

Homatropine  may  be  preferable  as  a  pupil  dilator  but  cannot  re- 
place atropine  in  the  treatment  of  ocular  maladies.  A  single  ap- 
plication, may  determine  the  access  of  glaucoma,  hence  the  intra- 
ocular tension  should  always  be  tested  before  applying  atropine.  In 


64  ATROPINE 

superficial  inflammations  of  the  cornea  with  photophobia,  especially 
if  complicated  with  maladies  of  the  iris,  atropine  acts  by  arresting 
the  amoeboid  movement  and  migration  of  the  while  cells,  and  by- 
preventing,  by  arterial  dilatation  and  acceleration  of  the  blood- 
current  in  the  inflamed  part,  the  adhesion  of  wandering  cells  to  the 
lining  of  the  capillaries  and  veins  (Binz). 

Deep  corneal  ulcerations  threatening  perforation,  and  conditions 
with  increased  intraocular  pressure,  contraindicate  the  use  of 
atropine.  Affections  of  the  iris,  however,  form  the  special  field 
for  atropine,  its  instillation  being  prophylactic.  Adhesions  due  to 
inflammation  can  often  be  prevented ;  synechiae  rupture  by  atropine, 
alone  or  alternated  with  physostigmine.  Van  Renterghem  speaks 
of  the  improved  results  secured  from  the  use  of  atropine  when  con- 
joined with  the  internal  use  of  aconitine,  veratrine  and  digitalin  for 
fever  and  inflammation,  quinine  for  the  access,  morphine  and  croton- 
chloral  for  pain,  and  antidiathetics  like  mercury  iodides,  etc.,  as 
indicated. 

In  headache  due  to  eye-strain  the  local  application  of  atropine  to 
the  conjunctiva  often  affords  great  relief.  In  immature  cataract 
and  spasm  of  accommodation,  instillations  of  atropine  solution  arc 
used  with  benefit.  There  is  little  danger  of  systemic  poisoning  from 
this  local  use  of  atropine,  except  in  idiosyncrasies.  If  the  solution 
is  allowed  to  become  alive  with  microorganisms  and  is  used  long, 
granulation  of  the  eyelids  may  arise.  This  is  prevented  by  employ- 
ing solutions  certainly  sterile.  Some  persons  are  so  susceptible  to 
atropine  that  the  skin  flushes  at  the  least  contact  with  it.  Sometimes 
the  mydriasis  persists  for  months  instead  of  subsiding  within 
a  week. 

The  internal  uses  of  atropine  spring  primarily  from  its  power  of 
paralyzing  the  peripheral  nerve-ends.  The  difficulty  of  sharply  dif- 
ferentiating the  toxic  from  the  medicinal  dose,  and  the  contradic- 
tory results,  are  the  reasons  this  mighty  medicament  has  not  at- 
tained the  notable  place  it  probably  deserves  (Liebreich). 

In  painful  affections  of  the  skin,  mucous  membranes  and 
muscles,  atropine  has  been  administered  with  success. 

As  a  muscular  relaxant  atropine  finds  employment  in  spasmodic 
conditions,  sphincter  constrictions,  spasm  of  smooth  muscular  fiber, 
especially  circular,  in  cesophagismus,  cardialgia,  colics  intestinal, 
hepatic,  renal,  uterine,  spasm  of  the  neck  of  the  bladder,  of  the 
uterus,  of  the  vaginal  and  urethral  orifices,  of  the  anal  sphincter. 

In  all  pathologic  contractions  or  excessive  activity  of  non-striated 


ATROPINE  65 

muscle-fiber,  in  the  tenesmus  of  dysentery,  nocturnal  enuresis,  the 
use  of  atropine  is  well  established ;  especially  in  lead-colic,  whose 
phenomena  may  be  completely  dissipated  by  atropine  (Harnack). 
By  relieving  spasmodic  contraction  of  the  muscular  coat  of  the 
bowel,  it  relieves  obstruction.  Hence,  in  strangulated  hernia  it  has 
been  given  with  most  satisfactory  results.  Oppenheider  gave  it  in 
nine  cases  of  obstinate  painful  constipation  from  hepatic  cancer, 
peritonitis,  etc.,  and  obtained  relief  from  full  "toxic"  doses.  Nor- 
man Kerr  reported  five  similar  cases,  three  having  fecal  vomiting, 
all  successful.  It  is  indicated  in  all  cases  of  high-grade,  persistent 
constipation,  where  enemas  and  saline  cathartics  fail  and  drastics 
cause  pain ;  also  where  opiates  and  chloral  have  been  used  to  relieve 
pain  (Oppenheider).  In  this  category  come  many  cases  usually 
ranked  as  appendicitis  of  the  catarrhal  form,  and  obstructions  fol- 
lowing the  ingestion  of  indigestible  food,  such  as  berries,  in  very 
large  quantities-.  Too  many  of  these  are  subjected  to  the  knife,  too 
many  die  after  the  action  of  violent  cathartics ;  but  such  cases  yield 
readily  when  brought  under  the  influence  of  atropine,  with  hot 
colonic  flushing  and  saline  laxatives. 

Rarely  do  these  states  depend  on  one  morbid  factor  alone ;  so  that 
with  atropine  we  associate  strychnine  or  brucine  as  general  in- 
citants,  morphine  and  cicutine  to  subdue  nervous  hyperesthesia,  and 
among  other  agents  in  combating  various  phenomena. 

In  the  convulsive  stage  of  whooping-cough,  in  spasmodic 
asthma,  and  all  irritative  coughs,  atropine  prevents  the  spasm.  It 
finds  application  as  an  antispasmodic  in  dystnenorrhea,  uncontrol- 
lable vomiting,  volvulus,  invagination  and  strangulated  hernia. 

In  all  these  atropine  requires  the  aid  of  modifiers :  Calcium 
sulphide,  apomorphine,  and  quinine  hydroferrocyanate  in  whooping- 
cough  ;  strychnine  and  arsenic  in  asthma ;  ergotin,  iron,  quinine, 
strychnine,  in  dysmenorrhea ;  brucine,  strychnine,  morphine  for 
vomiting;  strychnine  for  intestinal  strangulation. 

Atropine  serves  well  for  constipation  or  for  diarrhea.  By  relax- 
ing intestinal  spasm  it  reestablishes  the  regularity  of  the  evacua- 
tions ;  by  arresting  exaggerated  peristalsis  and  glandular  secretion 
it  arrests  intestinal  fluxes. 

The  property  of  moderating  secretion  has  been  utilized  in  the 
night-sweats  of  phthisis,  exaggerated  salivation,  bronchorrhea, 
diarrheas,  and  some  claim,  in  lactorrhea.  Ebstein  obtained  good  re- 
sults in  the  salivation  of  a  hemiplegic.  In  phthisis  atropine  combats 
the  sweats,  the  diarrhea  and  the  cough.  In  bronchorrhea  it  calms 


66  ATROPINE 

the  cough,  lessens  the  reflex  -irritability  of  the  mucosa,  checks  the 
hyper-secretion  and  acts  as  an  antispasmodic.  In  incontinence  of 
urine  it  lessens  the  hyperesthesia  of  the  vesical  mucosa.  It  subdues 
the  irritability  of  the  uro-genital  mucosa  in  spermatorrhea. 

In  the  choleras,  Asiatic,  infantile  and  morbus,  Brunton  had 
pointed  out  how  exactly  atropine  antagonized  the  pneumogastric 
irritation  constituting  the  disease,  and  Hankin  first  proved  the  truth 
of  the  deduction  by  using  atropine  in  Asiatic  cholera  with  remark- 
able success.  In  cholera  infantum  a  hypodermic  of  atropine,  suited 
to  the  age,  gives  speedy  relief ;  but  should  not  be  relied  upon  to  the 
neglect  of  intestinal  antisepsis. 

Its  sensory-paretic  action  renders  it  of  value  in  neuralgias*  and 
in  some  neuroses ;  trigeminal,  odontalgia,  otalgia,  sciatica,  epilepsy, 
chorea ;  in  neuralgia,  combining  with  morphine,  strychnine,  quinine, 
aconitine ;  in  chorea  with  salicylates,  arsenates,  vermifuges,  strych- 
nine, brucine;  in  epilepsy  with  glonoin,  cicutine,  verbenin. 

Atropine  valerianate  has  been  recommended  in  epilepsy  by 
Schroeder,  van  der  Kolk  and  many  others ;  but  not  in  grand  mal  due 
to  sexual  excitation. 

In  eclampsia  and  hysteric  spasms  it  has  been  administered  with 
varying  results.  When  glonoin  is  given  in  the  first  stage  of  epileptic 
spasms  to  dilate  the  cutaneous  vessels,  atropine  should  be  added  to 
prolong  the  effect. 

Of  late  atropine  has  been  very  largely  used  to  supplant  opium 
as  a  remedy  for  pain.  So  many  varieties  of  pain  are  amenable  to 
atropine,  and  the  danger  of  forming  an  atropine  habit  being  ab- 
solutely nil,  the  tendency  is  to  be  favored.  In  neuralgias,  the  pallid, 
shrunken  skin,  contracted  pupil,  weak,  repressed  pulse,  are  directly 
antagonized  by  atropine,  which  recalls  the  blood  to  the  surface  and 
relieves  the  internal  congestions.  In  spasmodic  pains  of  every 
description,  atropine  is  also  the  direct  physiologic  remedy. 

In  hemorrhages  of  every  variety  atropine  has  proved  one  of  the 
most  powerful  hemostatics.  A  full  dose  should  be  given  at  once, 
hypodermically,  enough  to  flush  the  skin.  If  the  blood  be  with- 
drawn from  the  bleeding  vessels  to  the  skin  it  is  necessarily  out  of 
danger. 

Many  persons  can  break  up  a  commencing  acute  catarrh  by  tak- 
ing a  full  dose  of  atropine. 

In  combating  morphine  poisoning  atropine  should  be  given  in 
doses  of  0.002  (gr.  1-30)  repeated  hourly  until  symptoms  of 
atropine  are  manifest,  such  as  dry  mouth,  reddening  face,  bright 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


ATROPINE  0V 

eyes,  dilating  pupils.  Beyond  the  beginning  of  toxic  action  it  is 
unsafe  to  go,  especially  as  the  antidotal  effects  of  atropine  do  not 
cover  the  entire  range  of  action  of  morphine.  And  in  poisoning  by 
the  galenic  preparations  of  opium  it  is  well  to  remember  that  the 
convulsant  effects  of  atropine  may  be  aided  by  an  unusual  propor- 
tion of  the  tetanisant  alkaloids  of  opium,  thebaine,  laudanine,  etc. 
The  cardiac  and  respiratory  depression  of  opiates  is  antidoted  by 
atropine,  and  its  use  is  to  be  directed  solely  against  these  features 
.of  opium  poisoning,  by  no  means  against  the  somnolence. 

Atropine  is  indicated  in  the  cerebral  inflammations  with  retarded 
pulse,  and  in  eruptive  fevers  with  delayed  eruption  and  evidences 
of  a  nervous  system  overwhelmed  by  the  onset  of  the  malady. 

In  grave  collapse  in  any  form  of  narcotic  poisoning  its  property 
of  allaying  the  excitability  of  the  cardiac  vagus  extremities  can  be 
utilized. 

As  an  oxytocic  atropine  may  be  employed  alone  or  combined 
with  ergotin,  strychnine  or  macrotin. 

Administration. — It  is  in  all  cases  best  to  administer  atropine 
by  the  intensive  method.  The  dosimetric  granules  are  all  too  large 
for  accurate  dosage.  One  containing  gr.  i-iooo  would  be  preferable. 
Of  these  one  may  be  given  to  an  adult,  best  in  solution,  every  five 
to  twenty  minutes,  according  to  the  urgency  of  the  case,  until  the 
first  evidence  of  action  is  manifest.  This  is  almost  invariably  dry- 
ness  of  the  mouth ;  only  exceptionally  do  any  of  the  classic  symp- 
toms precede  this.  When  this  dryness  is  felt  it  is*  time  to  stop  the 
drug,  as  the  full  benefit  has  been  secured,  and  if  full  relief  has  not 
ensued,  some  other  remedy  is  needed,  or  surgical  intervention.  This 
does  not  apply  in  poisoning  cases. 

Children  bear  atropine  well,  in  larger  doses'  proportionally  than 
adults,  but  not  all  children.  Double  the  dosage  by  Shaller's  rule 
with  all  but  flaxen  blondes,  and  halve  it  with  them. 

When  the  dose  for  a  patient  has  been  determined  with  accuracy 
this  may  be  given  with  advantage  at  once,  especially  when  dealing 
with  neuralgias  and  neuroses,  where  it  is  an  advantage  to  deal  a 
staggering  blow  to  the  malady  at  the  outset,  and  timid  medication 
will  fail.  So  in  urgent  cases,  cholera,  colics,  etc.,  it  may  be  best  to 
give  a  full  dose  at  once. 

Van  Renterghem's  advice  as  to  adjuvants  and  combinations, 
given  above,  can  be  largely  extended,  by  adding  each  other  remedy 
indicated  in  each  particular  case.  Obviously,  we  can  only  supply 


68  ATROPINE 

the  ingredients  and  general  directions.     Whether  the  cake  will  turn 
out  satisfactorily  must  depend  on  the  cook. 

'  Liniments  containing  atropine  are  usefully  applied  to  the  soles 
of  the  feet  in  hyperidrosis.  Atropine  represses  the  secretion  of  milk 
when  applied  to  the  breast.  The  local  uses*  of  atropine  are  as  legiti- 
mate in  liniments  and  plasters  as  in  solutions  applied  to  the  eye. 

Atropine  is  rapidly  excreted  by  the  kidneys.  It  enters  the  milk 
and  the  fetal  circulation,  and  should  not  be  given  to  a  nursing 
mother. 

In  poisoning  by  atropine,  the  convulsions  may  be  controlled  by 
ether,  the  heart  and  respiration  sustained  by  caffeine.  Recovery  is 
the  rule. 

Death  has  resulted  from  the  use  of  0.12  (gr.  i  5-6)  of  atropine 
internally,  and  in  the  case  of  a  consumptive,  of  only  0.04  (gr.  2-3). 

Appended  is  a  list  of  maladies  in  some  phases  of  which  atropine 
has  proved  of  benefit : 

Therapeutic  Summary.  — Abortion  :  Increases  uterine  contractions 
and  checks  hemorrhage. 

Abscess  :     Apply  locally  to  abort  by  vasodilation,  and  relieve  pain. 

Acidity:     Checks  hyperchlorhydria. 

Acne :    For  greasy  skin  with  free  sweating. 

Adenitis :    Locally,  relieves  pain  and  favors  resolution. 

After-pains :     Steady  contraction  relieves  pain. 

Alcoholism :  The  basis  of  all  secret  cures ;  the  fullness  of  the 
head  which  it  causes  renders  the  liquor  effect  disagreeable. 

Aphonia :    The  hysteric  form  ha&  been  relieved  by  full  doses. 

Asthma :    When  the  skin  is  cool  and  moist,  sputa  loose. 

Bladder,  Irritable:  Sedates  irritability,  checks  nocturnal 
enuresis. 

Roils :    Applied  in  plaster,  relieves  pain  and  hastens  maturation. 

Bronchitis :  To  check  profuse  mucous  flow,  bronchorrhea,  to 
relieve  irritative  cough. 

Calculi,  Biliary:  To  relax  spasm  of  ducts  and  let  stone  pass, 
easing  pain. 

Calculi,  Renal :  To  relax  spasm  of  ureter  and  allow  stone  to  pass. 

Cataract :     Immature  forms  benefited  by  instillations. 

Catarrh,  Acute  Nasal :    To  abort  the  attack  and  dry  up  secretion. 

Cerebral  Anemia :   To  increase  temporarily  cerebral  blood-supply. 

Cerebral  Congestion :    For  less  active  forms  of  hyperemia. 

Cholera  Asiatica:  Directly  opposes  the  vagus  irritation  in- 
dicated by  symptoms,  for  cramps,  pain,  diarrhea. 


ATROPINE  ••,«.» 

Cholera  Infantum  :     Same  as  preceding. 

Cholera  Morbus  :     Same  as  preceding-. 

Chordee :    Relieves  all  but  febrile  cases. 

Chorea :  For  cerebral  anemia,  as  antispasmodic,  as  hypnotic  in 
small  dose. 

Colic,  Intestinal :      Relieves  spasm,  pain,  constipation. 

Colic,  Lead :    The  best  remedy  for  pain,  spasm,  obstruction. 

Constipation  :     Small  doses  paralyze  inhibition,  allay  spasm. 

Convulsions :  For  congestive,  teething  or  whooping-cough 
forms. 

Cough  :  Spasmodic,  nervous,  sympathetic,  asthmatic,  allays  ir- 
ritation. 

Croup :     Relieves  irritation  and  stimulates  respiration. 

Cystitis :  Relieves  irritability,  breaks  attacks  due  to  catching  cold. 

Delirium :     Relieves  that  of  cerebral  anemia. 

Delirium  Tremens  :  For  insomnia  with  cyanosis,  cold  skin,  coma 
vigil. 

Dementia :     Stimulates  cerebral  circulation,  relieves  insomnia. 

Dengue :     For  sweating  stage,  when  excessive  or  weakening. 

Dentition  :     For  the  convulsions. 

Diabetes  Insipidus :    Checks  excessive  flow. 

Diarrhea :  Checks  excessive  flow,  choleraic,  colliquative,  irrita- 
tive. 

Diphtheria :  Given  early,  aborts  exudation,  later  to  sustain  heart, 
when  throat  and  tonsils  are  acutely  inflamed  and  swollen. 

Dysmenorrhea :  For  spasmodic  or  neuralgic  cases,  dark  fetid 
discharge,  crampy  pains  and  chills. 

Dyspepsia :  To  relieve  constipation  and  gastralgia,  check  hyper- 
chlorhydria. 

Dyspnea  :     Relaxes  spasm. 

Dysuria :     For  strangury,  bloody  urine. 

Eczema :     For  eczema  of  the  hand. 

Emissions:  For  atony  and  relaxation  of  genitals,  both  sexes. 

Emphysema :     Relieves  the  dyspnea. 

Enuresis  :    Nocturnal,  of  children,  full  dose  at  bedtime. 

Epilepsy :  For  nocturnal,  too  sound  sleepers,  petit  Dial,  to  dis- 
sipate cerebral  anemia  of  first  stage. 

Erections :    Are  strengthened  by  full  doses  and  fear  allayed. 

Erysipelas:  Superficial  non-vesicular  forms,  adynamic  phleg- 
monous  or  cerebral. 

Erythema :     To  wind  up  protracted  attacks. 


70  ATROPINE 

Eye  Affections :    Especially  for  iris  maladies. 

Feet:    For  fetid  perspiration. 

Fevers :  For  delayed  eruptions,  insomnia  and  low  delirium, 
photophobia,  hebetude,  hemorrhages,  to  sustain  heart. 

Gastralgia :    To  relieve  neuralgic  pain. 

Gastric  ulcer:  To  stop  pain  and  vomiting,  check  acid  produc- 
tion. 

Glottis,  CEdema :  It  may  prove  capable  of  drying  up  the 
effusion. 

Gout :    Very  effective  in  relieving  pain  of  gout  of  stomach. 

Hay  Fever :  By  drying  up  the  secretion  gives  temporary 
relief. 

Headache :  Breaks  up  attacks  of  excessive  meat-eaters.  For 
pain  over  eye,  photophobia,  intolerant  of  noise  or  motion,  uterine, 
gastric,  in  young  women;  face  pale  and  skin  shrunk,  pulse  small 
and  contracted. 

Heart  disease:    For  irregular  rhythm,  cardiac  strain. 

Hematemesis:    Full  doses  stop  bleeding. 

Hemoptysis:  In  full  doses  probably  the  best,  strongest  and 
quickest. 

Hemophilia :  Success  reported  recently  in  checking  hemor-" 
rhages. 

Hemorrhage,  Rectal :     Has  been  highly  recommended. 

Hemorrhage,  Puerperal :  The  quickest,  strongest,  best  hemo- 
static. 

Hemorrhoids :    To  stop  bleeding  and  relax  spasmodic  sphincter. 

Hernia :    To  relax  strangulation,  full  doses. 

Herpes  Zoster:    To  relieve  pain. 

Hiccough :  Full  doses,  to  relieve  spasm,  with  strychnine  to 
steady  nerve. 

Hypochondria:  For  cerebral  anemia,  general  relaxation,  sexual 
atony. 

Hysteria:    For  convulsions,  aphonia,  puerperal  forms. 

Impotence:    To  strengthen  erections  and  relieve  nervous  dread. 

Influenza :  For  headache,  acute  attacks,  free  sweating  or  other 
discharges. 

Insomnia:  For  prostration,,  low  arterial  tension,  contracted 
pupils,  frontal  headache,  over-use  of  eyes. 

Intestinal  Obstructions:  Full  doses  to  relax  spasm  and  relieve 
pain. 

Iritis :     Dilate  the  pupil  fully,  by  local  or  general  use. 


ATROPINE  71 

Keratitis:  If  ocular  tension  be  low,  contracts  vessels,  limits  in- 
flammation. 

Labor :  Stimulates  uterine  contractions,  lessens  pain  and  bleed- 
ing- 
Lactation  :  Checks  flow  of  milk.  Affects  nursling. 

Laryngismus  Stridulus :    Cuts  short  the  paroxysm. 

Locomotor  Ataxia :    Recommended  by  Brown-Sequard. 

Lumbago :    A  hypodermic  relieves  acute  attacks. 

Mania:  Allays  irritation,  induces  sleep,  quiets  delirium,  for 
nymphomania,  hypochondria,  delusions  or  persecution,  whenever  it 
is  desirable  to  stimulate  the  cerebral  circulation. 

Mastitis :    Relieves  congestion  and  dries  up  milk. 

Measles :  Depression  of  vital  powers,  low  temperature,  delayed 
eruption. 

Melancholy:     For  constipation  and  low  arterial  tension. 

Menorrhagia :    The  best  of  the  hemostatics. 

Myalgia :     Hypodermic  to  abort  acute  attacks. 

Myelitis :     For  traumatic  cases  and  anemic  conditions. 

Nephritis :    For  irritation  and  pain  in  kidneys  in  acute  form. 

Neuralgia :  Full  dose  at  once  to  break  up  attack.  Sciatica,  lum- 
bago, uterine,  ovarian,  intercostal,  dysmenorrheal,  tic,  spinal 
irritation. 

Obesity:    To  check  excessive  sweating. 

Oesophagismus :  To  relax  spasm,  ease  irritable  stricture  or  ulcer. 

Orchitis :    As  soon  as  the  acute  symptoms  subside. 

Otalgia :    For  children,  with  coryza. 

Otitis :    To  relieve  pain. 

Ovarian  Neuralgia:  The  best  remedy,  says  Waring. 

Paralysis :     For  chronic  myelitic  paresis. 

Perspiration:    For  phthisis,  debility,  relaxation  of  weak  children. 

Pertussis :  To  abort  attack  in  incubation,  check  spasm  and 
secretion. 

Pharyngitis :     Relieves  pain  and  fever,  aborts  attack. 

Photophobia:     Dilate  the  pupil. 

Phthisis:  For  colliquative  sweats,  diarrhea  or  bronchorrhea, 
irritative  cough,  dyspnea. 

Pleurodynia :    For  all  but  rheumatic  or  uterine  forms. 

Pneumonia :    In  the  first  stage,  infants,  to  check  secretion. 

Prostatorrhea :    To  check  discharge  and  subdue  irritability. 

Pruritus :    For  obstinate  cases  and  those  due  to  sweating. 

Rectal  ulcer ;    Relieves  pain,  especially  burning  after  stools, 


72  AVENINE 

Rheumatism  :    Excessive  sweating  may  demand  atropine. 

Roseola:    For  the  sore  throat  and  sweating,  delayed  eruption. 

Scarlatina :    To  bring  out  delayed  eruption,  for  sore  throat. 

Sciatica :    Hypodermic  down  to  sciatic  notch. 

Scurvy:    For  excessive  salivation  or  relaxation. 

Sea-sickness :  Empty  bowels  and  bring  under  atropine  to  pre- 
vent attack. 

Sneezing:    Dries  up  secretion  and  allays  irritability. 

Spasm:  For  local  muscular  spasm,  sphincter,  hysteric,  anemic, 
teething. 

Spermatorrhea :  For  relaxed  genitals,  nocturnal  emissions,  no 
orgasm. 

Sunstroke :  For  heat  exhaustion,  all  cases  with  low  arterial 
tension. 

Syncope :  Glonoin  at  once,  atropine  to  prolong  cerebral 
hyperemta. 

Tetanus:     Injected  near  wound  has  cured. 

Tonsillitis :    With  aconitine  used  early  will  abort  attack. 

Trismus :     Inject  into  affected  muscle. 

Typhoid  Fever :  Contracted  pupils,  low  muttering  delirium, 
weak  heart. 

Ulcers :     Has  remarkably  favorable  influence  over  their  course. 

Urticaria :     Gives  temporary  relief. 

Variola :  Low  muttering  delirium,  prostration,  delayed  eruption 
danger. 

Vomiting:    Relieves  that  of  pregnancy,  if  neurotic. 

This  list  merely  comprises  some  uses  of  atropine  that  are  well 
known  to  every  practician.  Many  others  will  suggest  themselves 
to  our  readers,  and  of  equal  importance  with  the  foregoing.  In 
truth,  it  is  doubtful  if  any  other  single  drug  does  as  many  things 
as  this,  and  does  them  as  well. 


AVENINE. 

Standard  granules — Gr.  1-67,  gm.  .001  of  the  alkaloid;  gr.  1-6,  gm.^.oi 
of  the  concentration. 

Merck  lists  avenine,  an  alkaloid  found  in  small  proportion  in  the 
common  oat.  Avenin  is  a  body  resembling  legumin,  containing  17 
parts  of  nitrogen  to  one  of  oxygen.  The  entire  plant  is  crushed  to 
a  pulp  when  the  grain  is  in  the  milk,  and  treated  with  strong  alcohol. 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


BAPTISIN  7.3 

Aveniti  was  introduced  by  Benjamin  Keith,  as  a  remedy  for 
paralysis.  He  had  suffered  from  this  and  found  no  remedy  that 
proved  of  benefit  until  he  tried  avenin.  He  firmly  believed  in  the 
efficacy  of  avenin  and  advocated  it  energetically.  The  writer  pre- 
scribed avenin  for  a  man  who  had  had  a  stroke  of  hemiplegia  some 
years  previously.  The  patient  took  the  remedy  two  weeks,  and  re- 
ported no  effects.  In  two  weeks  more  he  believed  it  was  doing  him 
some  good.  At  the  end  of  another  fortnight  he  was  sure  of  it,  and 
continued  to  take  the  avenin  for  a  year,  firmly  convinced  of  its  use- 
fulness. And  this  has  been  the  general  result  of  the  writer's  use  of 
avenin  in  similar  cases,  though  not  without  exception.  Just  wherein 
the  benefit  lay  is  unknown — the  patients  are  sure  of  it,  and  prize  the 
remedy,  finding  it  a  comfort  and  their  unpleasant  sensations  relieved. 

Avenin  has  been  recommended  as  a  remedy  to  ease  the  alcohol  or 
morphine  habitue  to  cease  the  use  of  his  drugs. '  The  writer  has  tried 
avenine,  avenin  and  Keith's  tincture  in  alcohol  and  morphine  cases, 
and  found  some  benefited  but  the  majority  obtained  no  benefit.  It 
is  worth  trying,  and  generally  forms  an  ingredient  of  the  tonics  used 
for  this  purpose. 

Sometimes  persons  not  ill  complain  of  feeling  languid  and  unre- 
freshed  on  rising  in  the  morning.  A  small  dose  of  avenine,  five 
granules,  in  a  glass  of  hot  water  on  going  to  bed,  will  be  followed 
by  a  sound  sleep  and  a  sense  of  rest  and  strength  next  morning. 

King  gives  as  the  specific  indications  for  avenine :  Spasmodic 
and  nervous  disorders,  with  exhaustion ;  cardiac  weakness ;  nervous 
debility  of  convalescence ;  spermatorrhea  from  the  nervous  erethism 
of  debility:  tensive  articular  swellings.  A  nerve  tonic,  stimulant 
and  antispasmodic. 

BAPTISIN. 

Standard  granule — Gr.  1-12,  gm.  .005. 

From  the  root  of  Baptisia  tinctoria,  wild  indigo,  are  derived 
baptism,  baptin  and  baptitoxine.  Schroeder  pronounced  the  first 
and  second  inert,  and  his  verdict  has  been  generally  accepted.  He 
found  baptitoxine  tonic  in  small  doses,  highly  toxic  in  large,  hasten- 
ing the  respiration,  exaggerating  the  excitomotor  power  and  caus- 
ing death  by  asphyxia. 

Plugge  claims  that  baptitoxine  is  identical  with  cytisine,  ulexine 
and  sophorine.  Kobert  found  the  symptoms  of  cytisine  resembling 
those  of  strvchnine  somewhat,  but  with  vomiting  of  centric  origin ; 


74  BAPTISIN 

cytisine  depresses  the  ozonizing  property  of  the  red  blood  corpuscles 
during  life;  it  excites  and  then  paralyzes  the  respiratory  center; 
powerfully  stimulates  the  vasomotor  centers,  producing  marked 
elevation  of  blood-pressure  independent  of  the  heart,  followed  (after 
large  doses)  by  fall  of  pressure  from  vasomotor  center  paralysis 
The  motor  tract  of  the  spinal  cord  is  strongly  excited  by  small  doses, 
paralyzed  by  large  ones.  The  peripheral  ends  of  the  motor  nerves 
are  paralyzed  as  with  curarine.  Cytisine  also  stimulates  the  uterine 
muscle  and  has  often  produced  abortion. 

Cytisine  has  also  been  recommended  for  paretic  migraine  and 
cardiac  dropsy,  mucous  irritability,  nervous  dyspepsia,  restlessness 
from  mental  overwork,  and  frequent  vomiting  from  slight  excita- 
tion. 

Specific  Indications. — Ellingwood  calls  baptisin  a  bitter  glucoside, 
baptin  a  purgative  glucoside,  and  baptitoxine  a  toxic  alkaloid.  Spe- 
cific indications  for  baptisia  are :  Mucosa  of  mouth  dark,  purplish ; 
tongue,  dry  and  thin  with  dark  coating;  face  dusky  and  suf- 
fused; circulation  feeble.  It  has  a  dynamic  influence  on  the  in- 
testinal glands,  antagonizing  disease  influences  there,  reinforcing 
the  blood,  preventing  destruction  of  the  red  corpuscles  and  stimulat- 
ing the  removal  of  debris.  In  malignant  tonsillitis  and  diphtheritic 
croup,  and  in  phagedena  tending  to  gangrene,  it  has  proved  curative. 
It  is>  useful  in  dysentery  with  offensive  breath  and  prune-juice  stools  : 
and  in  scarlet  fever,  when  the  specific  indications  above-described 
are  present?  In  low  fevers  baptisia  sedates  the  fever  markedly,  and 
soothes  cerebral  excitement. 

Scudder  gives  as  indications  for  baptisia :  face  full,  dusky,  pur- 
plish red,  like  one  who  has  been  in  the  cold  for  a  long  time;  tongue 
the  same  dusky,  purplish  color ;  headache  dull,  pulse  oppressed.  This 
condition  is  met  in  zymotic  and  other  maladies.  The  pulse  is  fast, 
fever  high,  the  ordinary  sedatives  and  baths  do  not  have  their  usual 
effects.  The  pulse  and  fever  fall  under  baptisia.  Continued,  scarlet 
and  typhoid  remittent  fevers,  dysentery  and  diarrhea,  furnish  indica- 
tions, often  on  the  first  day.  When  gastrointestinal  inflammations 
tend  to  necrosis  or  gangrene,  baptisia  enjoys  high  repute.  It  is  a 
useful  gargle  in  similar  throat  diseases,  the  malignant  forms  of 
scarlatinous,  variolous,  diphtheritic  and  mercurial  sore  throat,  and 
ulceration.  Topically  it  is  also  applied  to  syphilitic  ulcers,  white 
swellings,  "fever  sores ;"  phagedenic,  foul,  fetid  and  gangrenous 
ulcers,  sore  nipples,  chronic  and  scrofulous  ophthalmia,  fetid  leucor- 
rhea  and  genital  ulcers.  It  is  a  local  tonic  and  excitant  to  the  vessels 


BAPTISIN  75 

and  tissues.  It  should  be  given  internally  at  the  same  time.  Cloths 
saturated  with  a  strong-  decoction  should  be  applied  to  the  abdomen. 

Webster  terms  baptisia  a  dynamic  antiseptic  and  antizymotic. 
not  acting  chemically  but  by  stimulating  the  vital  functions.  This 
is  especially  true  of  the  intestinal  glands,  and  also  of  the  blood  in 
septic  and  epidemic  maladies.  It  is  also  useful  whenever  there  is  a 
tendency  to  gangrene.  Prune-juice  expectoration  in  pneumonia  is 
an  indication.  He  reports  a  case  of  ischio-rectal  cellulitis  with 
gangrene  and  systemic  toxemia,  recovering  under  baptisia  and  rhus 
tox. 

Merck  lists  Baptisin,  pure,  purgative  in  large  doses,  tonic-as- 
tringent in  small;  dose  0.032 — 0.3.  Also  Baptisin  (Eclectic),  dose 
0.05—0.52. 

Brunton  classifies  baptisin  as  a  hepatic  stimulant  of  secondary 
power,  and  says  it  also  stimulates  intestinal  peristalsis.  N 

Bocquillon-Limousin  says  baptisin  is  used  for  erysipelas  and 
affections  of  the  liver. 

Liebreich  says  baptisia  is  employed  as  a  protective  against  horse- 
flies. 

The  conflicting  reports  as  to  the  effects  of  baptisia  are  probably 
due  to  varying  proportions  of  the  three  diversely  endowed  active 
principles.  Among  the  Eclectics,  not  only  the  three  authors  quoted, 
but  numerous  magazine  articles,  there  is  a  remarkable  unanimity 
as  to  the  value  of  this  plant  and  the  uses  to  which  it  i&  put.  It  must 
be  noted  that  by  them  it  is  invariably  used  in  small  doses,  from 
one-fourth  to  five  minims  of  the  specific  tincture,  which  corresponds 
to  the  fluid  extract  in  strength. 

The  conditions  in  which  baptisia  is  used  are  those  in  which  the 
vital  powers  are  overwhelmed  by  septic  poisons,  either  in  the  whole 
body  or,  more  commonly,  in  a  part.  Hence,  when  reaction  appears 
deficient,  when  the  systemic  powers  are  not  able  unassisted  to  throw 
off  the  disease,  and  death  of  the  whole  or  a  part  is  impending, 
baptisia  is  prescribed  with  the  utmost  confidence.  The  action,  there- 
fore, is  analogous  to  that  of  capsicum  or  sanguinarine  in  pharyngitis. 

It  will  be  time  enough  to  deny  the  possibility  of  such  an  action 
when  we  know  just  what  constitutes  vitality,  and  the  laws  that 
govern  it.  Meanwhile,  the  important  question  is  simply  whether 
these  assertions  are  founded  on  fact.  Sometimes  a  man  makes  an 
observation — certain  phenomena  present,  a  drug  is  given,  and  re- 
covery ensues.  He  credits  the  drug  with  the  cure,  and  many  other 
physicians  employ  it  in  similar  cases.  Successes  are  reported,  fail- 


76  BARIUM    CHLORIDE 

ures  are  not.  And  so  the  repute  of  the  drug  as  a  remedy  is  made — 
arid  yet  the  whole  sequence  was  coincidental,  not  consequential ;  and 
an  error  is  engrafted  on  medical  practice,  that  may  cost  hundreds  of 
mistakes  and  many  lives  before  it  is  detected  and  expelled. 

On  the  other  hand,  the  presumption  in  such  cases  is  in  favor  of 
a  principle  whose  correctness  is  attested  by  many  men.  I  have  been 
unable  to  find  in  my  therapeutic  library  any  record  of  a  real  trial 
given  by  the  regular  medical  school  to  baptisia ;  nothing  but  the  dis- 
trusting, slighting  tests,  ready  to  accept  the  slightest  excuse  for  dis- 
missing with  contempt,  usually  accorded  remedies  emanating  from 
irregular  sources.  If  the  drug  really  possesses  the  properties 
claimed,  it  will  be  indeed  a  valuable  addition  to  our  resources.  In 
baptisin  we  have  a  useful  bitter  tonic  resembling  quassin,  in  baptin  a 
cholagogue,  one  of  these  also  stimulating  peristalsis.  Baptitoxine 
is  probably  the  most  important  ingredient,  to  which  the  vital  incita- 
tion  is*  to  be  attributed.  It  would  be  interesting  to  note  the  effect  of 
this  upon  the  leucocytes.  Whether  depression  of  the  ozonizing 
capacity  of  the  red  blood  corpuscles  interferes  with  bacterial  opera- 
tions, is  a  question  for  the  future ;  but  there  can  be  little  doubt  but 
that  the  powerful  stimulation  of  the  vasomotor  centers  is  beneficial 
when  vital  depression  threatens  life.  The  spinal  motor  excitation 
also  has  its  use.  It  is  also  noteworthy  that  the  vasomotor  excitation 
is  altogether  independent  of  the  heart. 

While  baptisia  is  ranked  by  the  eclectics  among  the  antiseptics, 
the  action  is  radically  different  from  that  of  the  chemical  disinfec- 
tants. Baptisia  enhances  the  vitality  of  tissues  threatened  with  de- 
struction, enabling  them  to  resist  the  tendency  to  death.  So  far  as 
we  know  this  claim  has  not  been  made  for  any  other  remedy  except 
echinacea.  If  true,  we  have  in  baptisia  an  agent  whose  value  could 
scarcely  be  overestimated.  Its  field  would  include  all  the  maladies 
in  which  there  is  an  overwhelming  of  the  vital  forces  by  disease 
causes,  "germs."  including  erysipelas,  diphtheria,  typhoid  fever, 
smallpox,  scarlet  fever,  measles,  phagedena,  dysentery,  cerebro- 
S'pinal  meningitis,  all  affections  characterized  by  ulceration  or  sup- 
puration, or  gangrene.  Webster  suggests  its  use  in  mania,  melan- 
cholia and  dementia,  with  stupor,  and  all  affections  with  drowsiness 
or  typhoid  states. 

BARIUM  CHLORIDE. 

Standard  granule — Gr.  1-6,  gm.  .01. 

The  salts  of  barium  were  popular  a  century  ago  as  remedies  for 
scrofula,  syphilis,  heart-diseases  and  aneurism.  In  Italv  thev  are 


MAR  I  I'M   CHLORIDE  77 

given  in  chorea  major  and  tetanus.  Brown-Sequard  recommended 
them  for  paralysis  agitans. 

Physiologic  Action. — Barium  chloride  stimulates  the  intestinal 
motor  ganglia,  causing  powerful  peristalsis,  even  cramps,  choking, 
dysenteric  stools  and  vomiting.  The  blood-pressure  is  increased  by 
contraction  of  peripheral  vessels,  then  falls  below  normal.  The 
pulse  is  first  rapid  and  irregular,  then  slows;  ending  with  heart- 
paralysis  and  asphyxia.  Respiration  is  labored.  Tinnitus,  diplopia, 
cramps  from  irritation  of  the  medulla,  and  paralyses,  show  the  ef- 
fect on  the  nervous  system.  Autopsies  show  inflammation  and 
ecchymoses  in  the  stomach  and  bowels.  Barium  was  detected  in  the 
blood,  urine,  spleen,  liver  and  kidneys.  The  fatal  dose  for  man  is 
from  4.0  to  10.0  ( i  to  2^2  drams).  Death  does  not  occur  for  several 
days. 

Cushny  says  that  in  lethal  closes  barium  chloride  stimulates  the 
spinal  cord  and  the  medulla,  causing  violent  tonic  and  clonic  con- 
vulsions. It  causes  very  active  peristalsis,  and  increases  the  blood- 
pressure  enormously.  The  effect  on  the  heart  muscle  is  antagonized 
by  potash.  Barium  is  partly  stored  in  the  bones,  partly  excreted  in 
the  urine  and  the  feces. 

When  used  in  medicinal  doses  for  prolonged  periods,  chronic 
toxic  symptoms  may  occur,  nausea,  diarrhea,  catarrhs,  cardiac  and 
nervous  depression.  Barium  seems  better  tolerated  in  hot  climates. 
In  the  north  daily  doses  of  0.3"  (gr.  v)  have  caused  unpleasant 
symptoms. 

The  dose  of  barium  chloride  has  been  fixed  at  gr.  1-6  repeated 
every  hour  till  the  desired  effect  has  been  obtained.  This  is  better 
than  the  doses  recommended  by  the  text-books,  which  are  so  varied 
as  to  indicate  considerable  variation  in  the  purity  and  strength  of  the 
specimens  found  in  the  shops.  The  dose  of  barium  chloride  usually 
given  is  0.03  to  0.12  (gr.  ^  to  2),  three  times  a  day. 

Toxicology. — Barium  carbonate  is  used  as  a  rat  poison.  It  is  con- 
verted into  the  chloride  in  the  stomach. 

In  poisoning  with  barium,  empty  the  stomach  by  emetics  and 
lavage,  and  give  sodium  or  magnesium  sulphate  in  large  doses,  to 
form  the  insoluble  barium  sulphate.  Sustain  the  heart  with  cardiac 
tonics.  Ogier  and  Socquet  reported  a  case  of  death  in  five  hours 
from  swallowing  20  grams. 

Therapeutics. — Liebreich  pronounces  barium  valueless  in  sclerosis 
of  the  nerve  centers.  Barium  sulphate  is  an  ingredient  of  depilatory 
powders. 


78  BAROSMIN.    BEBEERINE 

Brunton  and  Hare  recommend  the  chloride  as  a  rapidly  acting- 
heart-stimulant,  steadying  the  rhythm  and  increasing  the  volume  and 
force  of  the  systole. 

Epstein  has  given  it  in  hypertrophy  of  the  heart  with  abdominal 
aneurism,  with  excellent  results. 

Barium  chloride  has  been  especially  studied  by  Hare.  He  finds 
that  it  slows  the  heart,  steadies  the  rhythm,  increases  the  quantity  of 
blood  propelled  by  each  systole,  and  raises  the  arterial  pressure  by 
acting  on  the  muscular  coats  of  the  blood-vessels.  In  toxic  doses  it 
causes  overstimulation,  with  systolic  contractions,  the  vagi  not  being 
paralyzed  but  overcome  by  the  powerful  cardiac  contraction.  He 
advocates  this  agent  in  all  forms  of  failure  of  the  cardiac  muscle,  and 
in  varicose  veins,  the  muscle-stimulation  extending  to  the  veins  as 
well  vas  the  arteries.  Barium  doe&  not  cause  the  tense  pulse  of 
digitalis,  the  pulse-wave  being  more  prolonged. 

BAROSMIN. 

Standard  granule — Gr.   1-6,  gm.'.oi. 

Barosmin  is  a  resin  derived  from  buchu.  This  plant  has  had 
quite  a  reputation  as  a  remedy  for  chronic  inflammations  of  the 
genitourinary  tract.  Irritability  of  the  bladder,  uric  acid  deposits, 
chronic  urethritis,  the  incontinence  of  diseased  prostate,  especially 
profuse  mucous  or  mueopurulent  discharge  with  vesicorenal  irrita- 
tion (Felter- Lloyd). 

It  is  indicated  when  the  irritation  depends  on  altered  secretion 
from  the  urethral  glands.  Acid  urine,  incessant  calls  to  empty  the 
bladder  with  little  relief,  call  for  barosmin.  Catarrh  of  the  bladder 
from  extension  of  gonorrhea,  from  irritant  injections,  i&  relieved  by 
it.  For  this,  and  for  long  standing  irritability  with  difficulty  in  re- 
straining the  flow  of  urine,  Lloyd  recommends  buchu  and  iron.  He 
gives  as  specific  indications  for  buchu :  Abnormally  acid  urine,  with 
constant  desire  to  urinate,  little  relief  following;  vesicorenal  irrita- 
tion ;  copious  mucous  or  mueopurulent  discharges ;  cystorrhea. 
The  uses  of  barosrnin  are  amply  fulfilled  by  arbutin. 

BEBEERINE. 

Standard  granule — Gr.  1-6,  gm.  .01. 

From  the  Nectandra,  Pareira,  Boxwood,  Cissampelos  and  other 
plants,  are  derived  alkaloids  that  are  believed  to  be  identical,  and 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


BENZOIC    ACID  79 

represented  by  bebeerirre.  This  is  extracted  by  a  process  similar 
to  that  for  extracting  quinine.  It  occurs  in  yellowish  amorphous 
masses,  slightly  soluble  in  water,  freely  in  dilute  acids,  in  five  parts 
absolute  alcohol  or  in  thirteen  parts  of  ether.  The  sulphate  as  found 
commercially  is  very  impure,  containing  about  one-third  by  weight 
of  the  alkaloid  (King).  It  is  found  in  reddish-brown  scales,  solu- 
ble in  water  or  in  alcohol. 

In  its  effects  bebeerine  closely  resembles  quinine.  In  small  dose.s 
it  is  tonic,  and  in  large  ones  antimalarial.  It  is  antiseptic  along  the 
same  lines,  stopping  the  movements  of  the  leucocytes  and  of  lower 
organisms.  It  increases  the  appetite,  relaxes  the  pulse  a  little,  and  in 
large  doses  causes  ringing  of  the  ears  and  cerebral  fullness,  quite 
as  quinine  does. 

Therapeutics. — In  malarial  fevers  bebeerine  is  useful  but  not  equal 
to  quinine.  It  has  been  praised  in  periodic  headaches  and  neuralgias ; 
especially  in  strumous  and  phthisical  patients.  It  has  proved  effec- 
tive in  stopping  the  exhausting  sweats  of  consumption.  King  rec- 
ommends it  for  strumous  ophthalmia,  and  as  a  useful  tonic  during 
pregnancy.  Scudder  praises  it  as  a  remedy  for  menorrhagia,  when 
the  flow  is  too  frequent  and  too  free.  In  leucorrhea  also  the  tonic 
effect  has  been  found  equal  to  that  of  berberine.  The  dose  as  a  tonic 
is  gr.  1-12  to  j.  before  meals;  as  a  febrifuge  and  antiperiodic  gr. 
v — xx.  Boxwood  has  been  used  as  an  adjuvant  to  antisyphilitic  mix- 
tures, and  with  doubtful  indication  in  epilepsy.  In  chorea,  'hysteria 
and  chronic  rheumatism  its  tissue-toning  property  may  be  of  ad- 
vantage. Berberine  approaches  most  closely  in  action  to  bebeerine 
which  seems  to  stand  between  berberine  and  quinine.  In  this  day 
of  accurate  study  of  remedial  agents,  it  should  be  ascertained  if 
malarial  spleens  are  contracted  as  well  or  better  by  bebeerine  than 
by  the  hydrastis  alkaloid.  In  convalescence  from  malaria,  and  when 
quinine  has  not  agreed  or  has  lost  its  effect,  bebeerine  seems  to  be 

the  logical  substitute. 

t 

BENZOIC    ACID. 

Standard  granule— Gr.  1-67,  gm.  .001. 

Ben  zoic  acid  is  obtained  from  Benzoin  as  a  rule  or  made  arti- 
ficially from  Toluol.  Benzoin,  a  balsamic  resin  obtained  from 
Styrax  benzoin,  a  tree  indigenous  to  Java  and  Sumatra,  is  suf- 
ficiently common  and  inexpensive  to  render  it  undesirable  to  at- 
tempt sophistication  to  any  great  extent,  and  thus  the  larger  part 


80  BENZOIC   ACID 

of  the  benzoic  acid  on  the  market — especially  if  prepared  by  a  firm 
of  repute — is  the  genuine  product.  As  a  matter  of  fact  the  artificial 
acid  seems  to  answer  every  purpose  though  there  is  a  great  differ- 
ence in  the  clinical  results  obtained  from  a  number  of  samples. 
This  perhaps  is  one  reason  for  the  widely  differing  opinions  ex- 
pressed by  clinicians  as  to  the  value  of  this  remedy. 

Benzoic  acid  is  found  in  many  plants,  free  or  combined  with 
bases.  It  is  also  obtained  from  urine  but  it  is  impossible  to  obtain 
it  so  pure  as  to  have  no  urinous  odor.  It  may  be  obtained  by  oxida- 
tion from  cinnamic  acid,  oil,  of  bitter  .almonds,  cymol,  naphthalin, 
casein,  glue,  and  other  organic  substances. 

It  forms  loose,  shining,  yellowish  or  white  crystalline  needles 
or  plates,  of  aromatic  odor,  sweetish  taste,  followed  by  sharp,  rasp- 
ing. It  is  irritant  if  inhaled.  The  acid  is  soluble  in  370  parts  of 
cold  and  20  of  boiling  water,  in  7  of  chloroform,  2  of  alcohol,  and 
3  of  ether,  10  of  glycerin>  carbon  disulphide,  and  in  turpentine, 
evaporating  in  steam.  Borax  or  sodium  phosphate  increase  the 
solubility  in  water.  It  must  be  free  from  cinnamic  acid,  which 
when  oxidized  with  potassium  permanganate  exhales  the  odor  of 
bitter  almonds. 

Physiologic  Action. — When  benzoic  acid  passes  through  the  body, 
it  takes  up  amidoacetic  acid,  or  glycocoll,  and  appears  in  the  urine  as 
hippuric  acid.  This  takes  place  only  under  normal  conditions  of  the 
kidneys ;  when  they  are  disturbed  benzoic  acid  passes  unchanged. 
Part  is  eliminated  by  the  lungs  and  the  saliva  in  the  form  of 
benzoates  and  succinates. 

Benzoic  acid  as  an  antiferment  and  antiputrefactive  agent  acts 
more  powerfully  than  salicylic  acid  in  some  fluids,  such  as  beerwort 
and  putrefying  flesh  solution.  This  is  because  benzoic  acid  is  more 
loosely  combined  with  alkalies  and  more  easily  set  free  (Kolbe). 
One-tenth  of  one  per  cent  of  benzoic  acid  delays  the  development  of 
bacteria  in  a  nutrient  fluid,  and  two-hundredths  of  one  per  cent 
hinders  it.  The  propagation  of  bacteria  is  prevented  by  3  to  4  per 
1,000  of  benzoic  acid  (Bucholtz). 

In  man  benzoic  acid  traverses  the  body  in  combination  with  al- 
kalies, appearing  free  only  in  the  urine.  In  the  dog  benzoic  acid  in- 
creases considerably  the  dissolution  of  albumin,  without  hippuric 
acid.  If  the  doses  are  very  large  a  reducing  substance  is  formed, 
showing  the  body  to  be  super-saturated,  when  the  drug  must  be 
discontinued  (Salkowski).  Given  internally  in  large  doses  to 
animals  it  produces  paralysis,  great  lowering  of  temperature,  the 


BENZOIC    ACID  81 

pulse  and  respiration  at  first  faster,  then  slower,  with  death  from 
respiratory  paralysis.  It  is  more  irritant  to  the  mucosa  than  salicylic 
acid,  and  in  large  doses  causes  nausea  and  vomiting. 

It  is  used  as  a  dressing  for  wounds,  as  an  inhalant  in  pulmonary 
gangrene  and  putrid  bronchitis,  and  in  cigarettes  in  asthma,  chronic 
bronchitis  and  laryngitis.  Twenty  drops  of  tr.  benzoin  in  a  pint  of 
boiling  water  makes  a  good  inhalation. 

Frerichs  urged  benzoic  acid  in  uremia,  assuming  that  the  am- 
monia developed  from  urea  is  neutralized  and  rendered  harmless  by 
this  acid.  This  theory  has  not  been  confirmed  by  clinical  observa- 
tion (Penzoldt).  Basing  his  recommendation  on  the  antiseptic  qual- 
ities of  benzoic  acid,  and  attributing  the  therapeutic  efficacy  of 
salicylic  acid  to  this  property,  Senator  advised  sodium  benzoate  in 
acute  inflammatory  rheumatism,  especially  when  salicylic  acid  fails 
or  disagrees.  He  advised  the  prolonged  use  of  the  remedy  in  large 
doses. 

Benzoic  acid  has  also  been  given  in  puerperal  fever,  gout  and 
cholera  infantum.  Haberkorn  urged  it  in  scarlatina  and  erysipelas, 
but  experience  has  not  confirmed  this  use. 

In  pneumonia  of  the  aged  benzoic  acid  o.i — 0.5  (gr.  il/2 — 7/^2)  is 
given  with  camphor,  several  times  a  day,  and  even  up  to  ten  grams  a 
day  without  harm  (Liebreich).  Iron  benzoate  is  soluble  in  cod-liver 
oil,  and  is  sometimes  given  in  it. 

Synergists. — As  antizymotics,  salicylic  acid,  carbolic  acid,  resorcin, 
the  aromatics,  thymol,  volatile  oils;  while  alkalies  render  the  acid 
soluble  and  thus  favor  its  passage  into  the  blood. 

Antagonists. — There  are  none ;  but  acids  and  tannic  astringents 
hinder  the  absorption  of  benzoic  acid. 

Therapeutics. — Van  Renterghem  thinks  benzoic  acid  of  advantage 
in  asthenic  pneumonias,  chronic  bronchitis  and  whooping-cough,  as 
a  stimulant  expectorant. 

In  uremia,  dropsies  and  eclampsias  it  stimulates  the  elimination 
of  waste.  While  Huesemann  does  not  accept  Frerich's  view  as  to 
the  action  of  benzoic  acid  upon  ammonia,  he  finds  clinically  that  the 
acid  is  useful  in  nephritis.  In  conjunction  with  potassium  acetate 
and  chloroform  the  writer  has*  employed  this  acid  in  desquamative 
nephritis,  acute  and  chronic,  for  many  years,  with  gratifying  results. 
In  fact,  with  the  exclusive  skim-milk  diet,  it  has  taught  him  to  look 
upon  this  as  a  curable  malady  in  the  great  majority  of  cases. 

For  fetid  ammoniacal  urine  in  cystitis,  Van  Renterghem  finds 
benzoic  acid  useful,  but  inferior  to  boric  acid.  Burggrseve  employed 


82  BENZOIC   ACID 

benzoic  acid  because  uric  acid  is  replaced  by  hippuric  acid,  whose 
bases  form  in  the  blood  extremely  soluble  salts.  In  grave  pyrexias 
it  is  the  alkalinity  of  the  blood  especially  that  it  is  necessary  to  de- 
stroy, since  this  is  the  cause  of  the  ataxy  that  characterizes  these  af- 
fections. In  all  these  cases  benzoic  acid  fulfills  but  a  part  of  the  in- 
dications ;  the  alkaloids  must  be  added  as  indicated. 

Van  Renterghem  finds  doses  of  three  or  four  milligrams  (gr. 
1-20  to  1-15)  sufficient  to  obtain  the  benefit.  In  respiratory  affec- 
tions he  combines  strychnine  arsenate  or  brucine;  in  grave  fevers, 
typhoid,  typhus,  acute  uremia,  he  has  recourse  to  the  defervescents, 
quinine,  intestinal  lavage  with  neutral  magnesia  salts ;  in  chronic 
uremia,  special  modifications  as  the  symptoms  indicate. 

In  chronic  uremia,  Burggrseve  said :  "Amblyopia  may  cause  sup- 
pression of  vision,  from  subretinal  oedema ;  give  phosphoric  acid, 
strychnine  sulphate,  quinine  hydro ferrocyanate,  a  granule  each,  to- 
gether, every  hour.  Retinal  hemorrhage  is  distinguished  by  the 
ophthalmoscope.  Observe  if  the  pupils  preserve  their  contractility ; 
this  distinguishes  symptomatic  from  organic  amaurosis,  and  pre- 
vents useless  treatment  and  false  hopes.  Tinnitus,  etc.,  depend  on 
dryness  of  the  internal  ear  membranes.  Deafness  shows  cedema  of 
the  auditory  ossicles,  causing  vertigo,  incoordination  of  motion,  and 
hemicrania.  The  same  means  are  indicated  as  in  amblyopia.  Con- 
vulsions, usually  clonic,  are  clue  to  cerebral  anemia  or  hyperemia. 
They  are  epileptiform,  and  preceded  by  an  aura.  The  treatment 
varies  as  there  is  softening  or  sclerosis  of  the  spinal  cord.  In 
hydremic  epilepsy  give  iron  and  strychnine  arsenates,  and  digitalin, 
together,  of  each  three  granules  a  day.  The  bromides  are  not  in- 
dicated in  acute  spasms.  In  uremia  there  exist  often  intolerable 
pains  in  the  members  and  joints,  relieved  by  morphine  and  hyos- 
cyamine, of  each  a  granule,  together,  every  half-hour  till  sedation. 
With  salines  prevent  gastric  embarrassment,  due  to  biliousness. 
Gastralgias  and  enteralgias  are  calmed  by  strychnine  and  hyos- 
cyamine,  a  granule  each,  together,  every  half-hour  till  sedation.  For 
respiratory  troubles,  dyspnea,  angina  pectoris,  etc.,  as  they  may  end 
in  pulmonary  oedema,  oppose  them  without  delay  with  iron  and 
strychnine  arsenates,  and  hyoscyamine,  of  each  a  granule,  together, 
every  half-hour  till  sedation.  Individuals  addicted  to  alcohol  are 
liable  to  epistaxis ;  combat  the  hemorrhages  with  quinine  hydrofer- 
rocyanate,  iron  arsenate,  of  each  a  granule  together,  every  quarter- 
hour  till  the  bleeding  stops." 

In  urinary  affections,   digitalin,  hyoscyamine,  cicutine,  arbutin. 


83 

cubebin  and  strychnine,  can  be  called  to  aid  benzoic  acid  in  appro- 
priate cases  (Van  Renterghem). 

The  great  value  of  this  acid  and  its  salts  is  in  affections  of  the 
urinary  tract,  as  an  antiseptic,  soothing  irritation,  and  under  its 
administration  bacteria  disappear.  It  exerts  a  solvent  action  on 
calculi,  of  urates  or  phosphates.  King  says  the  indication  for  it  is 
ammoniacal  urine,  or  alkaline,  and  that  it  only  relieves  rheumatism 
when  the  urine  is  alkaline.  In  nocturnal  enuresis,  dysuria,  the 
dribbling  of  the  elderly  bladder,  in  gleet,  and  in  phosphaturia,  it 
gives  good  results  if  the  urine  is  alkaline.  Wood  affirms  that  under 
the  use  of  this  acid  the  uric  acid  crystals  rapidly  disappear  from  the 
urine.  Bird  praises  it  in  uricemia. 

Locally,  solutions  of  benzoic  acid  may  replace  the  tincture  of 
benzoin  for  freckles,  pityriasis  versicolor,  moth  patches,  chronic 
urticaria,  all  sorts  of  itchings,  for  chaps,  fissures,  old  sinuses,  and  as 
a  styptic.  As  an  application  for  unhealthy  wounds  and  ulcers,  the 
tinctures  have  had  a  reputation  for  ages ;  but  the  wisest  way  to  use 
them  is  as  preventive  of  unhealthy  states,  by  applying  them  to  fresh 
wounds,  when  the  benzoin  forms  a  protective  antiseptic  varnish  over 
the  exposed  surfaces. 

Shoemaker  gives  the  following  application  for  freckles  and 
moth :  Corrosive  sublimate  gr.  ss,  tr.  benzoin  2^2  drams,  glycerin 
2  drams,  rose-water  to  make  6  ounces. 

Ammonium  benzoate  in  small  doses  stimulates  the  circulation, 
accelerates  the  blood-current,  and  thus  elevates  the  temperature  and 
increases'  the  secretions,  especially  those  of  the  bronchi  and  the 
sweat  glands.  In  large  doses  long  continued  it  causes  an  aplastic 
state  of  the  blood,  with  multiple  hemorrhages,  lesions  of  nutrition, 
and  profound  debility.  These  neutralizing  and  antiseptic  prop- 
erties render  it  suitable  in  typhoid  fever,  while  as  a  diuretic  it  re- 
lieves certain  dropsies.  It  dissolves  the  concretions  of  uric  acid, 
gravel  and  gouty  tophi.  As  a  stimulant  and  sudorific  it  is  useful  in 
atonic  arthritics.  It  stimulates  the  bronchial  mucosa  in  dry  catarrhs. 
The  dose  is  one  to  four  centigrams  (gr.  1-6  to  2-3)  four  or  five 
times  a  day. 

Lithium  benzoate. — Garrod  exposed  fragments  of  bone  covered 
with  urate  of  soda  deposits  to  solutions  of  lithia,  potash  and  soda : 
the  first  completely  dissolved  the  deposits,  the  potash  largely,  the 
soda  not  at  all.  In  gout  lithium  benzoate  acts  as  an  excellent 
diuretic ;  in  uric  gravel  as  a  dialytic  agent.  The  dose  is  the  same 
as  that  of  the  ammonia  salt. 


84  BENZOIC   ACID 

Calcium  benzoate  has  been  specially  recommended  as  a  remedy 
for  albuminuria. 

Sodium  benzoate  occurs  in  white  anhydrous  amorphous  powder, 
soluble  in  il/2  parts  of  water,  45  alcohol,  1.3  boiling  water,  20  boil- 
ing alcohol.  The  antifermentive  and  putrefactive  power  of  this  salt 
is  equal  to  that  of  the  pure  acid,  or  even  greater  (Bucholtz)  ;  as  5 
to  6  parts  to  10,000  prevent  bacterial  development. 

Large  doses  cause  trembling,  convulsions  and  ataxic  movements 
of  the  anterior  extremities,  progressing  to  complete  paralysis;  also 
vomiting,  gastric  hemorrhage,  but  no  diarrhea.  The  pulse  and 
respiration  are  first  made  rapid,  then  slowed.  The  temperature 
falls  very  low.  Death  occurs  from  respiratory  paralysis.  Sudden 
toxic  phenomena  appear  in  all  animals  experimented  upon,  if  the 
dose  exceeds  2-10  per  cent  of  their  weight  (Schulte).  In  man  five 
grams  causes  nausea  and  vomiting,  preventable  by  strong  exercise 
(Meissner).  In  addition  a  dose  of  fifteen  grams*  caused  dizziness, 
rapid  pulse,  subjective  heat,  sweating  and  expectoration  (Schreiber). 
In  fever  it  is  an  excellent  antipyretic. 

Like  benzoic  acid,  the  sodium  salt  is  used  as  a  stimulant  expec- 
torant in  catarrhs  of  feeble  or  aged  persons,  with  little  or  no  fever, 
the  bronchi  filled  with  secretions ;  also  in  pneumonias  occurring  in 
such  patients'.  Nothnagel  is  skeptical  as  to  its  efficiency  here,  as 
well  as  in  uremia,  uricacidemia,  erysipelas,  diphtheria,  typhus, 
polyarthritis  rheumatica,  cholera  in  fan  turn,  etc. 

Sodium  benzoate  stimulates  the  action  of  the  liver  and  increases 
the  elimination  of  nitrogen  by  the  kidneys.  In  some  cases  its  use 
has  occasioned  erythema,  papules,  or  urticaria. 

Shoemaker  speaks  of  it&  use  in  chronic  diarrheas  and  dysenteries, 
indigestion  from  torpidity  of  the  liver,  and  excessive  uric  acid  ex- 
cretion. As  an  antiseptic  it  has  proved  useful  in  acute  rheumatism, 
septic  fevers,  scarlatina,  variola,  diphtheria,  typhoid  fever,  whoop- 
ing-cough and  erysipelas.  In  rheumatism  it  disagrees  with  the 
stomach  in  large  doses  more  than  salicylic  acid. 

Klebs  recommended  sodium  benzoate  strongly  in  typhoid  fever, 
as  an  intestinal  antiseptic.  Its  use  in  tuberculosis  is  now  simply  a 
matter  of  history.  The  use  of  this  salt  in  diabetes  mellitus  i&  not 
very  encouraging  (Nothnagel). 

Dosage. — Acid  benzoic,  0.05  to  0.5  (gr.  i  to  7^)  at  each  dose. 

Sodium  benzoate,  0.5  to  4.0  (gr.  J1/*  to  60). 

These  are  the  old-fashioned  doses,  designed  to  flush  the  system 
several  times  a  day  with  a  flood  of  the  remedy.  Under  the  dosi- 


THERAPEUTIC   NOTES 


THERAPEUTIC    NOTES 


BERBERINE  «•> 

metric  system  it  has  been  found  better  to  keep  up  a  continuous  im- 
pregnation of  the  blood  with  the  remedy,  by  giving  small  doses, 
about  gr.  1-6  of  either  the  acid  or  any  one  of  its  salts,  every  half- 
hour,  or  one  or  two  hours,  according  to  the  acuteness  of  the  symp- 
toms it  is  designed  to  relieve.  The  efficiency  of  these  small  doses 
thus  given,  is  readily  demonstrated.  In  chronic  maladies  of  the 
urinary  apparatus  the  administration  should  be  continued  for 
months,  the  hygienic  precautions  necessary  being  taken  at  the  same 
time.  When  pus  is  passing  in  the  urine  at  the  same  time,  the  addi- 
tion of  arbutin  is  advisable,  and  in  gonorrheal  infections,  the  sul- 
phides of  lime  and  of  arsenic  may  be  added.  In  most  forms  of 
cystitis  it  is  also  wise  to  wash  out  the  bladder  with  a  saturated 
solution  of  boric  acid,  and  inject  a  dram  of  Euarol  three  times  a 
week.  But  the  use  of  these  accessory  measures  must  not  divert  the 
attention  from  the  persistent  administration  of  the  benzoates,  from 
which  so  much  may  be  expected. 

BERBERINE. 

Standard    granules — Gr.    1-67,   gm.    .001 ;  gr.    1-6.   gm.   .01. 

Berberine  is  the  most  universally  diffused  alkaloid  in  the  plant 
world.  It  is  found  in  a  multitude  of  plants  such  as  columbo,  the 
Berberidia?,  Menispermaceae,  Ononacese,  Ranunculaceae,  Papaver- 
aceae,  Rutaceae,  and  Csesalpineae.  Many  of  these  plants  have  ac- 
quired repute  as  tonics,  antiperiodics  and  astringents,  etc.,  the 
larger  part  of  the  credit  being  justly  due  to  the  berberine  contained. 

The  formula  of  berberine  is  C20  H17  NO4.  It  is  closely  related 
to  papaverine,  narcotine  and  hydrastine;  It  forms  yellow  nee- 
dles, insoluble  in  cold,  soluble  in  hot  water  and  in  alcohol,  insolu- 
ble in  ether.  Solutions  are  yellow,  and  very  bitter.  The  salts  are 
golden  yellow.  The  acetate  and  phosphate  are  most  soluble.  They 
are  more  soluble  in  pure  than  in  acidulated  water. 

Physiologic  Action. — Berberine  appears  in  the  bowels,  even  if 
given  subcutaneously,  but  not  in  the  urine.  It  acts  on  the  central 
nervous  system  (Falck),  first  paralyzing  the  automatic  centers,  then 
the  spinal  cord.  In  rabbits  hypodermic  injections  of  o.i  of  ber- 
berine sulphate  cause  death  with  paralysis  of  the  hind  legs,  con- 
vulsions, falling  of  temperature,  diarrhea,  and  weakening  heart  and 
respiration.  Death  is  due  to  asphyxia,  from  paralysis  of  the 
respiratory  center.  If  not  promptly  fatal,  albuminuria  occurs,  the 
renal  epithelium  becomes  swollen  and  turbid,  even  fatty.  But  0.8 
given  by  the  stomach  is  not  fatal,  but  simply  causes  diarrhea,  some- 


86  BERBERINE 

times  vomiting,  tremor,  rapid  pulse  arid  breathing  and  weakness. 
Repeated  administration  produces  anorexia  and  loss  of  weight.  In- 
creased peristalsis  is  noted  even  when  berberine  is  given  subcutane- 
ously  or  injected  into  the  bowel.  In  fatal  cases  the  latter  is  strongly 
contracted.  The  spleen  is  contracted  by  berberine  (Falck),  and  also 
the  uterus  (Fellner).  Small  doses  lessen  the  irritability  of  the 
vagus  and  slightly  hasten  the  pulse,  followed  speedily  by  slowing, 
as  the  excito-motor  ganglia's  irritability  is*  exhausted  (Marfori). 
Fatality  is  due  to  heart-exhaustion.  Small  doses  do  not  influence 
the  blood-pressure  but  large  ones  lower  it  decidedly. 

Berberine  stops  the  movements  of  the  leucocytes,  while  the  red 
corpuscles  become  granulated  and  their  contents  diminished,  the 
union  of  the  oxygen  with  the  hemoglobin  becoming  firmer. 

Recovery  from  effects  of  overdoses  of  berberine  is  slow.  The 
rapidity  of  the  pulse  appears  to  be  due  to  paralysis  of  the  cardiac 
inhibitory  nerve-ends,  and  to  the  attendant  fall  of  vascular  tension ; 
this  effect  being  exerted  on  the  vasomotor  centers  as  well  as  on  the 
heart.  Very  strong  solutions  exert  an  effect  upon  bacteria  and  upon 
the  leucocytes  analogous  to  that  of  quinine. 

Berberine  i&  in  part  excreted  by  the  kidneys  unchanged,  the  rest 
being  broken  up  in  the  body  (Cushny). 

Brunton  says  that  doses*  of  i.o  (gr.  15)  in  man,  taken  by  the 
stomach,  cause  only  slight  colicky  pains  and  diarrhea.  It  lessens 
the  oxidation  of  the  blood. 

Berg  took  3.6  (gr.  55)  of  berberine  without  any  inconvenience, 
so  that  in  man  this  agent  is  not  lethal  in  any  dose  likely  to  be  taken. 

Therapeutics. — Many  plants  containing  berberine  are  popular; 
columbo  as  a  simple  bitter,  hydrastis  as  an  astringent  bitter,  fraxinus 
as  a  contractor  of  tumors,  xanthoxylon  as  a  stimulant  to  unhealthy 
ulcers,  etc.  When  there  is  a  lack  of  tonicity  in  the  intestines,  with 
constipation  or  passive  laxation,  berberine  is  indicated.  It  has  re- 
cently been  highly  recommended  in  enlargement  of  the  spleen. 
Curci  praises  it  in  chronic  dysentery  and  gastrointestinal  catarrhs, 
while  Beil  advises  it  in  infants'  diarrheas. 

Fellner  used  it  in  menorrhagia,  Alaggiorani  and  others  in  chronic 
malaria,  Vehsemeyer  in  leukemia.  In  menorrhagia  berberine  acts 
only  by  contracting  the  uterine  tissue,  especially  in  subinvolution 
and  i&  less  effective  than  hydrastine,  which  is  still  inferior  to  hy- 
drastinine. 

Shoemaker  recommends  berberine  as  an  injection  in  gonorrhea ; 
as  a  remedy  for  dyspepsia,  malaria  and  atonic  diarrhea.  He  at- 


BERBERINE  87 

tributes  to  it  tonic,  antipyretic,  antiperiodic  and  cholagog  prop- 
erties. 

Macchiavelli  and  Reil  testify  also  to  its  value  in  malaria,  giving 
0.12  to  i.o  (gr.  2 — 15)  during  the  remission.  Lascarato  states  that 
the  contraction  of  the  spleen  caused  by  berberine  i&  so  powerful  that 
over-doses  cause  rupture  of  that  organ,  with  fatal  hemorrhage.  If 
the  spleen  is  degenerated  there  is  no  action.  This  shows  the  radical 
difference  between  berberine,  a  contractor  of  connective  and 
muscular  tissue,  and  ergotin  and  digitalin,  contractors  of  blood- 
vessels. Berberine  is  useless'  in  hemorrhages.  The  difference  be- 
tween the  latter  and  quinine  is  also  shown  by  the  access  of  fever  fol- 
lowing the  contraction  of  the  spleen ;  for  the  parasites  are  thereby 
simply  extruded  into  the  blood,  not  killed.  Therefore,  the  treatment 
of  malaria  should  include  berberine  to  force  the  parasites  out  of  the 
spleen  into  the  circulation,  and  quinine  and  arsenic  to  destroy  them. 

The  maximum  dose  of  berberine  in  malaria  is  i.o  in  24  hours; 
but  usually  it  suffices  to  give  o.oi  (gr.  1-6)  every  waking  hour.  In 
other  maladies  o.ooi  every  hour  is  sufficient;  for  berberine  is  em- 
phatically a  remedy  for  prolonged  administration  in  chronic 
maladies,  in  minimal  doses.  Thus  given,  its  effects  are  notably 
persistent,  sure  and  uniform. 

Looking  upon  berberine  as  a  stimulator  of  peristalsis  and  a  con- 
tractor of  relaxed  atonic  tissues,  it  has  been  extensively  advised  dur- 
ing the  past  year  in  cases  where  the  relaxation,  atony  or  defective 
contractility  of  the  tissues  seemed  to  be  a  bar  to  the  restoration  of 
health.  The  results  have  justified  tli£  high  expectation^  based  on 
this  agent.  It  deserves  to  rank  among  the  most  certain  and  generally 
useful  of  "condition-remedies,"  if  I  may  be  allowed  to  coin  an  ex- 
pression, at  our  command.  It  is  very  slow  in  manifesting  its  effects, 
but  once  secured,  they  are  permanent.  In  employing  berberine  to 
reduce  dilatation  of  the  stomach  the  diet  should  be  carefully  reg- 
ulated and  the  stomach  never  allowed  to  be  distended  by  overfilling 
or  chilled  by  iced  drinks.  It  seems  that  an  agent  so  frequently  met 
and  in  such  generous  proportions,  ought  to  be  furnished  by  the 
chemists  at  a  better  price ;  and  if  its  use  continues  to  increase,  it  will 
undoubtedly  become  cheaper.  But  the  best  effects  are  obtained 
from  small  doses  long  continued,  so  that  the  unavoidable  expense  is 
well  distributed. 

The  property  of  contracting  connective  tissue  points  to  several 
other  uses  to  which  berberine  could  be  put.  Dilatation  of  the 
stomach  has  in  many  hands  responded  admirably  to  its  influence, 


88  BOLDINE 

with  special  care  taken  never  to  allow  the  stomach  to  be  distended 
by  food,  or  to  be  chilled  by  cold  drinks.  However,  these  precautions 
avail  much  in  gastric  dilatation,  even  without  berberine ;  so  that  it  is 
uncertain  how  much  benefit  really  is  attributable  to  the  latter. 

But  in  dilatation  of  the  heart,  without  fatty  degeneration,  the 
use  of  berberine  in  conjunction  with  strict  limitation  of  the  use  of 
fluids,  is  a  far  more  rational  procedure  than  the  routine  administra- 
tion of  digitalis.  And  in  the  enlargement  of  the  liver  that  attends 
the  advanced  stages  of  valvular  cardiac  maladies,  we  have  a  field 
peculiarly  fitted  for  berberine.  If  this  drug  contracts  the  liver  as 
energetically  as  it  does  the  spleen,  its  use  would  be  exceedingly 
valuable  here. 

Granting  berberine  the  place  it  seems  to  fill,  that  of  inducing 
contraction  of  connective  tissue,  many  practical  applications  of  this 
principle  can  be  made.  For  instance,  in  goiter — but  I  have  said 
enough. 

BOLDINE. 

Standard  granule — Gr.   1-67,  gm.  .001. 

From  Peumus  boldo  are  derived  an  alkaloid,  boldine,  and  a 
glucoside,  boldo-glucin.  Boldine  increases  the  elimination  of  urea 
and  the  secretion  of  bile.  Taken  by  the  stomach  it  causes  a  bitter 
taste  (being  evidently  partly  eliminated  by  the  saliva)  and  a  sense 
of  heat  in  the  stomach.  It  increases  the  appetite  and  the  digestion 
as  well,  displaying  specific  action  upon  the  liver.  Chronic  hepatitis, 
jaundice,  hypertrophy  of  the  liver,  hepatic  colic  and  hepatic  maladies 
contracted  iri  the  tropics,  have  .been  successfully  treated  by  boldine. 
Bilious-  vomiting,  headache  and  jaundice  disappear  under  its  use. 

Houde  recommends  boldine  highly  as  a  remedy  for  gall-stones. 
Naunyn  says  that  these  are  formed  not  only  in  the  gall-bladder  but 
in  the  biliary  ducts.  Cholesterin  and  calcium  bilirubinate,  the 
principal  chemical  components  of  biliary  calculi,  come  from  the 
mucous  lining  of  the  biliary  passages.  The  lithogenic  mucous 
catarrhs  may  be  provoked  by  microbes  (bacillus  coli,  Eberth's  bacil- 
lus, etc.),  and  are  therefore  of  infectious  origin.  Such  catarrhs  are 
not  acute,  but  the  product  of  microbes  whose  virulence  is  much 
attenuated.  They  cause  stagnation  of  the  bile  in  the  ducts,  though 
not  a  total  obstruction,  the  bile  being  evacuated  normally.  Normal 
bile  is  scarcely  sterile,  the  colon  bacillus  being  sparsely  found  in 
this  fluid.  The  cause  of  concretions  is  found  in  the  retarded  flow. 

Some  calculi  form  rapidly,  others  more  slowly.  They  may  re- 
main a  long  time  in  the  gall-bladder  without  giving  rise  to  any 


BOLDINE  89 

symptoms  whatever.  They  do  harm  by  exciting  catarrh,  cholecys- 
titis and  cholang-eitis.  If  of  infectious  origin  the  bacilli  multiply 
rapidly.  The  calculi  interfere  with  complete  evacuation  of  the  bile, 
with  results  similar  to  those  due  to  the  retention  of  residual  urine 
in  the  urinary  bladder ;  as  the  residual  bile  forms  an  excellent  med- 
ium for  the  cultivation  of  infectious  bacteria.  Thus,  a  nidus  may  be 
formed  for  grave  autointoxications,  or  infections  of  the  bowels,  the 
colon  bacillus  becoming  very  virulent  in  residual  bile. 

The  resultant  cholecystitis  may  provoke  the  expulsion  of  the 
calculi,  producing  the  agonies  of  hepatic  colic  with  subsequent 
jaundice  or  the  attack  of  colic  may  itself  cause  the  cystic  inflam- 
mation. 

Recovery  may  ensue  in  every  stage  of  cholelithiasis  if  all  the 
concretions  are  evacuated,  by  the  gall-passages  or  through  fistulous 
tracks.  By  a  "cure"  is  meant  the  cure  of  the  infectious  element, 
when  the  malady  becomes  latent,  the  ducts  being  pervious.  This 
may  be  permanent  or  only  temporary.  The  most  approved  method 
of  cure  is  the  production  of  an  abundance  of  bile.  It  does  not  fol- 
low that  an  agent  that  will  produce  this  in  health  will  do  so  when  the 
biliary  passages  are  obstructed.  Cholagogs  lose  their  efficacy  in  the 
presence  of  infectious  cholangeitis. 

So  much  for  Xaunyn,  whose  skepticism  as  to  efficacious  treat- 
ment is  simply  the  expression  of  modern  European  therapeutic 
nihilism. 

Therapeutics. — Houde  places  boldine  in  the  front  rank  of  rem- 
edies for  cholelithiasis,  for  its  cholagog  action  is  rarely  wanting. 

Dujardin  Beaumetz  and  Bourgoin  found  it  notably  increased 
urea  elimination,  and  especially  the  bile  excretion,  without  affecting 
the  circulation,  the  temperature  or  the  quantity  of  the  urine.  This 
gives  to  boldine  the  character  of  a  true  hepatic  stimulant.  The  first 
notable  effect  is  an  increase  of  the  bile,  then  follows  a  diminution  of 
hepatic  congestion.  When  appendicitis  depends  on  defective  bile- 
supply  it  is  favorably  influenced  by  boldine.  which  sweeps  out  all 
organic  residues  whose  stagnation  sets  up  this  affection.  Boldine 
should  also  prove  effective  in  the  hepatic  maladies  consequent  on 
prolonged  residence  in  tropical  countries.  In  malarial  hepatitis 
boldine  has  not  proved  efficient,  unless  quinine  is  administered  at  the 
same  time.  Sodium  arsenate  renders  the  combination  still  more 
effective. 

Merck's  Index  for  1896  gives  the  dose  of  boldine  as  gr.  T-IO 
to  1-30.  and  the  price  as  $3.00  for  fifteen  grains. 


90  BOLDINE 

In  Parke,  Davis  &  Co.'s  Pharmacology  of  th*e  Newer  Materia 
Medica,  boldo  is  pronounced  by  Zaremba  most  useful  in  gonorrhea, 
in  atonic  dyspepsia  with  or  without  biliousness,  in  chronic  cystitis, 
in  chronic  hepatic  abscess,  and  as  a  powerful  anthelmintic.  Elim- 
inated through  the  urine,  boldine  increases  the  excretion  of  urea 
but  not  of  water.  The  glucoside,  boldo-glucin,  has  marked  hypnotic 
properties,  and  is  also  said  to  compare  favorably  with  cocaine  as  a 
local  anesthetic. 

Houde  advises  boldine  in  granules  of  o.ooi,  gr.  1-67,  each,  of 
which  six  to  twelve  should  be  given  daily.  I  have  prescribed  five 
to  ten  of  these  granules  together  at  bedtime,  with  very  good  results. 
In  one  case  where  the  renal  elimination  had  fallen  to  20  oz.  daily, 
containing  350  grains  of  solid  matter,  five  granules  at  bedtime  raised 
the  elimination  to  about  600  grains  and  the  quantity  to  64  oz.  In 
another  case,  the  elimination  of  solids  rose  from  300  grains  to  600 
and  800,  with  corresponding  improvement  in  the  symptoms  and  feel- 
ings. Two  cases  are  of  course  too  few  for  positive  conclusions,  but 
the  results  in  these  warrant  me  in  advising  a  trial  of  boldine  in  these 
cases  of  defective  elimination  which  have  proved  so  intractable  to 
treatment. 

Houde  says  that  "boldine  does  not  influence  the  circulation, 
temperature,  or  the  quantity  of  urine,  but  augments  sensibly  the 
elimination  of  urea  and  the  secretion  of  bile. 

"Laborde  found  boldo  exercising  primitively  a  hypnotic  action 
on  the  nervous  system,  with  temporary  suspension  of  the  functional 
acts  of  conscious  life  and  of  relation.  This  was  accompanied  by  a 
certain  degree  of  anesthesi-a,  general  and  of  special  senses,  notably 
of  hearing,  and  abolition  of  the  oculo-palpebral  reflex.  After  mor- 
phine, codeine,  narceine  and  hyoscyamine,  boldine  ranks  with  the 
secondary  hypnotics ;  but  its  action  on  the  liver  makes  it  precious 
in  cases  where  the  other  hypnotics  are  objectionable.  Here  boldine 
relieves  pain  and  favors  evacuation,  as  in  biliary  calculi  and  other 
forms  of  calculi  and  obstruction. 

"This  observation  of  Laborde  harmonizes  with  our  own.  Of  all 
the  hypnotics  we  have  tried,  but  one  resembles  boldine — narceine. 
The  sleep  induced  by  the  latter  leaves  a  certain  degree  of  con- 
sciousness, which  boldine  does  not,  but  the  awakening  is  as  free 
from  disagreeable  sensation  in  the  one  case  as  in  the  other.  Nar- 
ceine, like  all  opium  derivatives,  cannot  be  administered  during  di- 
gestion, at  least  during  the  first  part,  which  is  not  the  case  with 
boldine. 


THERAPEUTIC    NOTES 


BRUCINE  yi 

"Boldine  causes  considerable  increase  of  the  biliary  secretion, 
and  dissipates  hepatic  congestion  and  ftmctional  ailments  of  this 
organ.  In  simple  jaundice,  hepatic  colic,  chronic  hepatitis,  ap- 
pendicitis, and  hepatic  ailments  of  hot  or  unhealthy  countries,  the 
good  effects  of  boldine  are  no  less  manifest.  It  is  in  fact  a  specific 
for  hepatic  maladies  in  general,  even  for  cirrhosis. 

"Boldine  does  away  with  the  failures  encountered  in  using  boldo; 
due  to  manifest  insufficiency  of  the  dose.  Of  the  granules  contain- 
ing each  o.ooi  (gr.  1-67),  the  daily  dose  is  6  to  10,  which  are  al- 
ways efficacious  in  acute  hepatic  colic,  biliary  calculi  and  acholic 
jaundice.  One  kilogram  of  Iroldo  contains  .02  to  0.03  of  pure 
boldine.  so  that  the  effect  of  the  ordinary  medicinal  doses  of  the 
latter  are  insignificant. 

''Boldine  favorably  influences  appendicitis,  which  ends  without 
suppuration.  The  abundant  production  of  bile  induces  a  general 
evacuation  of  all  the  organic  residues  in  the  bowel,  whose  stagna- 
tion is  the  point  of  departure  of  inflammation  of  that  part  of  the 
intestinal  canal. 

"Boldine  ameliorates  alike  the  hepatic  affections  clue  to  any  form 
of  alcohol,  to  a  diathesis,  or  to  a  residence  in  hot  or  unhealthy 
countries.  Hypertrophies  of  paludal  origin  feel  its  good  effects  as 
well,  but  the  improvement  is  more  rapid  if  quinine  is  also  given. 
With  profound  debility,  sodium  arsenate  should  be  added.  Begin 
with  one  granule,  o.ooi  five  times  daily,  gradually  increasing  until 
the  daily  dose  reaches  ten  granules,  if  necessary  and  well  supported. 
But  if  the  hypnotic  effect  is  desired  give  a  granule  every  fifteen 
minutes  at  bedtime.  Six  granules  secure  6  to  8  hours  normal  sleep." 

BRUCINE. 

Standard  granule — Gr.  1-134,  Rm-  -0005. 

Brucine  is  the  companion  alkaloid  of  strychnine  in  nux  vomica 
and  ignatia.  Brucine  exists  in  nux  vomica  seeds  in  the  proportion 
of  y2  to  i  per  cent,  strychnine  being  present  in  from  *4  to  3~5  Per 
cent.  ' 

Brucine  is  soluble  in  320  parts  of  cold  and  in  150  parts  of  boil- 
ing water ;  in  alcohol,  very  freely  in  chloroform  or  in  benzole,  very 
slightly  in  benzine,  not  at  all  in  ether.  The  salts  are  freely  soluble. 
Brucine  is  even  more  bitter  than  strychnine. 

Physiologic  Action. — There  is  much  diversity  in  the  reports  on  the 
action  of  brucine,  partly  due  to  the  difficulty  experienced  in  getting  it 


92  BRUCINE 

free  from  strychnine.  Reichert  said  it  was  precisely  similar  in 
effects  to  strychnine,  except  that  the  latter  is  more  quickly  absorbed, 
and  exerts  forty  times  greater  convulsant  force;  brucine  having 
greater  toxicity  as  to  the  sensory  nerves.  Cushny  also  states  that 
brucine  exerts  much  more  action  on  the  nerve-ends  in  voluntary 
muscle  than  strychnine.  But  Wintzenried  says  brucine  stimulates 
the  spinal  cord,  paralyzes  the  motor  nerves  and  has  no  effect  on  the 
cerebrum  or  the  sensory  nerves ;  at  first  raising  and  then  depressing 
arterial  pressure ;  while  large  doses  paralyze  the  vagi,  death  occur- 
ring from  asphyxia.  When  taken  by  the  mouth  no  symptoms  en- 
sue, because  the  drug  is  excreted  as  fast  as  it  is  absorbed. 

Reichert  says  it  causes  a  brief  motor  paralysis  before  the  con- 
vulsions; but  Shoemaker  affirms  that  it  may  cause  death  without 
any  convulsions. 

Brunton  found  that  brucine  checks  oxidation  of  the  blood  and 
the  excretion  of  carbonic  acid ;  greatly  increases  reflex  excitability ; 
causes  tetanic  convulsions ;  acts  as  a  stimulant  to  the  respiratory 
center,  making  the  respirations  deeper  and  quicker,  and  the  lungs 
do  more  work. 

Although  brucine  requires  a  longer  time  for  absorption  than 
does  strychnine,  death  comes  sooner  when  lethal  doses  are  given, 
because  the  former  is  quicker  in  getting  to  work.  We  cannot  there- 
fore subscribe  to  the  view  of  Murrell,  that  brucine  is  only  a  mild 
strychnine  and  completely  represented  by  the  latter  in  small  doses. 
We  have  repeatedly  noted  the  quickness  with  which  the  effects  of 
brucine  are  manifested,  and  in  many  cases  this  is  of  the  utmost 
value,  as  time  may  not  be  allowed  for  the  slower  remedy. 

When  the  salts  are  employed,  and  administered  in  solution,  in 
hot  water  or  hypodermically,  the  effects  of  brucine  are  most  valu- 
able in  syncope,  from  sudden  loss  of  blood,  exhaustion  from  heat 
and  excessive  water-drinking,  or  from  the  effects  of  depressing 
drugs  or  exhausting  discharges. 

Therapeutics. — In  many  emergencies  the  speedy  action  of  brucine 
renders  it  preferable  to  strychnine.  By  its  quick  action  and 
speedy  elimination,  brucine  is  admirably  adapted  to  the  intensive 
dosage,  the  use  of  small  and  oft-repeated  doses.  While  it  is  said 
to  have  only  one-fortieth  the  strength  of  strychnine,  we  rarely  find 
it  advisable  to  give  more  than  gr.  1-67  to  1-134,  repeated  every  five 
to  thirty  minutes  till  the  requisite  degree  of  tonicity  is  attained. 
When  it  is  desired  to  keep  up  this  effect,  strychnine  may  be  given 
with  or  after  brucine.  In  emergencies  when  quick  action  is  emi- 


BRUCINE  93 

nently  or  urgently  indicated,  from  gr.  1-12  to  1-2  may  be  given  at 
once ;  but  personally  the  writer  has  never  found  it  necessary  to  ex- 
ceed gr.  1-8.  In  one  case  of  alarming  heart- failure  from  over-  ex- 
ertion, in  a  man  aged  over  seventy,  this  dose  was  gjven,  with 
atropine  gr.  1-134,  with  the  best  effect,  and  permanent  recovery 
ensued.  This  case  had  been  diagnosed  as  a  "hopeless"  case  of  heart- 
clot  by  a  distinguished  practician  and  teacher,  and  left  with  that 
prognosis. 

Merck  advises  his  brucine  in  doses  of  gr.  1-12  to  1-2;  maximum 
single  dose  gr.  3-4,  daily  3  grains. 

Mays  reported  that  brucine  exerts  a  marked  local  anesthetic 
effect,  in  solutions  of  5  to  10  per  cent.  This  has  been  confirmed  by 
Seiss,  who  pronounces  it  less  reliable  than  cocaine,  and  found  large 
doses  cause  nervous  irritability  lasting  several  hours.  The  writer 
has  employed  a  mixture  of  brucine  and  cocaine,  2  to  5  per  cent  of 
each,  in  some  cases  in  which  the  latter  alone  gave  rise  to  symptoms 
of  collapse,  with  excellent  effect. 

Burnett  tried  brucine  locally  in  pruritus,  etc.,  and  preferred  it  to 
cocaine.  In  chronic  forms  of  pruritus  it  is  effective,  and  preferable 
to  cocaine  as  not  being  liable  to  result  in  an  injurious  habit.  In  fact, 
this  local  anesthetic  effect  of  brucine  may  indicate  its  value  as  a  sub- 
stitute for  morphine  and  cocaine  when  used  hypodermically. 

In  making  solutions  of  brucine  salts  Wood  advises  the  addition 
of  one  drop  of  sulphuric  or  hydrochloric  acid  for  each  three  grains 
of  the  drug.  The  antidotes  are  chloral,  chloroform  and  tannic  acid. 

The  seeds  of  mix  vomica  contain  about  2.88  per  cent  of  alkaloid, 
equally  divided  between  strychnine  and  brucine;  Strychnos  tieute 
contains  1.429  per  cent  of  strychnine  and  traces  only  of  brucine; 
Strychnos  ignatia  has  1.39  per  cent  strychnine  and  traces  of  brucine; 
the  bark  of  false  angostura  and  that  of  Strychnos  colubrina  contain 
about  2.4  per  cent  of  brucine  and  traces  of  strychnine ;  Strychnos 
ligustrina  has  brucine  alone ;  and  Strychnos  gautheriana — Hoangnan 
— contains  traces  of  strychnine  and  2.7  per  cent  of  brucine.  These 
are  but  averages,  the  true  composition  of  each  differing  in  various 
samples ;  so  that  the  use  of  the  galenic  preparations  of  these  potent 
plants  gives  a  variety  and  uncertainty  the  reverse  of  pleasing. 
Palck  examined  some  specimens  and  found  the  tincture  containing 
from  0.244  to  0.353  per  cent,  the  alcoholic  extract  from  7.3  to  8.59 
per  cent,  equally  divided  between  strychnine  and  brucine ;  while  the 
aqueous  extract  contained  3.18  to  4.3  per  cent,  one-fifth  strychnine 
and  four-fifths  brucine. 


94  P.RYONIN 

Brucine  is  for  children  and  persons  in  feeble  health  what  strych- 
nine is  for  adults  and  persons  strongly  constituted.  For  the  child 
brucine  is  the  incitant  par  excellence.  Brucine  may  be  given  to  in- 
fants a  granule  at  a  time,  every  quarter  hour  in  acute  cases,  till 
effect ;  four  to  six  granules  a  day  in  chronic  affections,  with  other 
remedies  as  indicated.  For  adults  very  susceptible  to  strychnine 
two  to  four  granules  may  be  given  at  each  dose  (Van  Renterghem). 

BBYONIN. 

Standard  granule — Gr.  1-67,  gm.  .001. 

From  Bryonia  dioica  is  derived  the  glucoside  bryonin.  It  is 
colorless,  very  bitter,  soluble  in  water  and  in  alcohol,  insoluble  in 
ether  or  in  chloroform. 

Large  doses  of  bryonin  cause  grave  inflammation  of  the  stomach 
and  bowels,  vomiting,  uncontrollable 'diarrhea,  vertigo,  fall  of  heat, 
dilation  of  the  pupils,  cold  sweating,  colic,  collapse,  extremely  small 
pulse,  and  death  (Felter-Lloyd).  Bryonin  is  less  irritant  than  the 
galenic  preparations  and  in  moderate  doses  is  simply  laxative. 

Therapeutics. — Bryonin  has  been  recommended  for  convulsions 
due  to  intestinal  worms,  for  dropsy,  chronic  inflammations  with  en- 
larged glands  or  serous  effusions :  in  scarlet  fever  to  prevent  ear 
complications ;  chronic  orchitis,  rheumatism,  pleurisy,  pulmonic  dis- 
orders, fevers,  to  relieve  constipation  (Felter-Lloyd). 

The  authors  just  quoted  enumerate  its  uses  as  follows:  Lung 
diseases,  for  sharp,  cutting,  lancinating  pain  with  harsh  cough ; 
pain  intense  and  tearing,  worse  on  motion,  parts  feel  stiff,  sore  and 
bruised,  much  mucus  in  bronchioles ;  pulse  hard,  frequent  and 
vibratile,  high  fever ;  right  cheek  flushed :  for  serous  inflammations, 
peritonitis,  or  synovitis ;  frees  circulation,  overcomes  capillary  ob- 
struction, lowers'  fever  and  controls  pain ;  lessens  nervous  excitation 
and  erethism,  and  promotes  secretion  and  excretion ;  rheumatic 
conditions  of  the  chest  and  pleurodynia ;  best  in  pleurisy,  especially 
if  insidious  and  complicated,  when  bryonia  stimulates  absorption  : 
bilious  pleurisy,  pleuropneumonia,  bronchitis  with  blood-streaked 
sputa,  pneumonia  with  pleuritic  pain  or  short,  sharp  cough,  worse 
on  motion ;  in  typhoid  pneumonia,  with  baptisia ;  in  phthisis  to  con- 
trol pain,  fever  and  cough ;  for  cough  and  pain  in  influenza  excels 
all  other  remedies  but  gelsemium ;  laryngeal  and  tracheal  cough ; 
dry,  rasping,  hacking  and  explosive,  with  tensive,  sharp  pains ;  lit- 
tle secretion  :  irritative  cough  aggravated  by  talking,  eating,  or  en- 


BRYONIN  95 

tering  a  warm  room ;  the  condition  is  a  debility  and  patients  sweat 
easily ;  often  controls  fever  when  ordinary  remedies  fail :  chilliness, 
tension  and  easy  sweating  indicate  bryonin  ;  with  peculiar  pains, 
deepened  color  of  mucosa  and  full  veins,  frontal  headache,  drv 
tongue,  and  tendency  to  delirium. 

It  is  excellent  in  hepatic  disorders  with  jaundice,  high-colored 
urine  and  pain  on  pressure,  stitching,  sticking  or  cutting  pains  about 
liver ;  acute  or  chronic  rheumatism  ;  painful  and  stiff  spine  in  chil- 
dren, rheumatic  headache,  sharp  temporal  or  frontal  pain,  tender 
scalp,  worse  on  motion;  rheumatism  of  fingers  (Locke):  ovarian 
and  menstrual  wrongs  with  tenderness :  acute  mammitis :  partial 
deafness  from  cold  or  scarlet  fever ;  scrofulous  eyes,  ears,  ulcers  and 
synovitis.  with  stinging,  burning  pains:  tensive  earache  in  children: 
facial  neuralgia  with  weak  heart,  cold  hands  and  feet:  rheumatic 
iritis  with  pain  on  moving  eyeball :  heart-strain  and  organic  heart 
troubles  when  exposure  and  rheumatic  twinges  bring  on  the  par- 
oxysms ;  peritonitis  with  colicky  pain,  unusual  tenderness  and  ten- 
sion :  pericarditis  tending  to  hydropericardium :  brain  disorders 
with  serous  exudation  :  indigestion,  food  lying  heavy  like  a  stone : 
typhoid  fever  with  pulmonary  complications ;  abdominal  tenderness 
and  pain  in  typhomalaria,  zymotic  diseases  and  in  cholera  infantum 
with  ipecac  or  euphorbia  (Scudder). 

Scudder  gives  the  specific  indications  for  bryonia  as :  A  hard 
vibratile  pulse,  flushed  right  cheek,  frontal  pain  extending  to  basilar 
region,  pnd  irritative  cough. 

Felter  and  Lloyd  insist  on  the  pain  worse  on  motion  as  a  cardinal 
characteristic. 

We  have  given  the  eclectic  accounts  of  this  drug  in  full  because 
it  is  one  they  value  very  highly.  In  the  writings  of  the  regular 
school  but  little  is  to  be  found  on  this  once  popular  remedy.  Van 
Renterghem  tried  bryonin  on  his  own  person,  taking  gr.  1-12  every 
hour  till  gr.  1-2  had  been  taken.  No  abdominal  pain  ensued,  nor 
action  on  the  bowels,  the  night  was  passed  in  comfort  and  at  6  a.  m. 
he  was  awakened  by  the  calls  of  the  bowels,  passing  semi-solid 
stools.  The  action  follows  in  8  to  12  hours.  Doses  of  gr.  'y2  to  il/2 
purge  violently  with  atrocious  pains  and  choleraic  symptoms.  As 
synergists  he  enumerates  jalapin,  colocynthin  and  elaterin :  with 
podophyllin  in  large  doses.  Atropine  is  an  excellent  auxiliary  and 
corrigent,  by  its  antispasmodic  power  and  as  regulator  of  peristalsis. 
Morphine,  cotoin  and  tannic  acid  antagonize  bryonin.  He  suggests 
its  use  as  a  succedaneum  for  podophyllin.  Acting  specially  on  the 


96         BUTYL  CHLORAL  HYDRATE 

cecum,  bryonin  relieves  this  and  the  colon  from  torpor.  The  field 
for  it  is  in  abdominal  torpor,  bilious  fevers  and  dysenteries,  vermin- 
ous and  stercoral  colics.  To  him  it  is  evidently  a  cathartic  and  no 
more. 

Shaller  found  that  bryonin  stimulated  the  kidneys,  increasing  the 
quantity  of  urine.  He  recommends  it  in  all  forms  of  dropsy,  to 
promote  absorption  of  the  effused  liquid.  For  torpid  liver  and 
biliousness  he  finds  it  of  value.  In  serous  inflammations,  after  fever 
has  been  reduced  by  aconitine,  there  frequently  remain  various  pain- 
ful and  annoying  conditions  that  may  last  years ;  such  as  the  head- 
aches after  meningitis,  the  stitch  in  the  side  after  pleurisy,  the 
precordial  pain  of  chronic  pericarditis  and  the  joint  ails  after  rheu- 
matism— all  which  are  cured  by  bryonin.  The  principal  field  for 
bryonin  is  in  the  alleviation  and  cure  of  chronic  inflammations  of 
serous  membranes.  He  advises  doses  of  gr.  2-67  every  two  hours 
till  decided  physiologic  action  is  denoted  by  thorough  evacuation  of 
the  bowels;  then  half  this  dose.  If  pain  ensues  he  adds  atropine. 
Several  weeks  are  required  to  cure  chronic  affections. 

Dr.  W.  B.  Robertson  found  a  few  granules  relieve  the  stiffness 
following  long  bicycle  rides  by  a  novice. 

Dr.  C.  Stanton  gave  gr.  1-67  every  fifteen  minutes  for  neuralgic 
headache  and  got  relief  from  the  second  dose.  To  a  lady  who  had 
stopped  menstruating  for  two  months  from  cold  he  gave  gelsemin 
gr.  1-134  and  bryonin  gr.  1-67  every  half-hour  till  the  menstrual 
discharge  appeared,  which  was*  less  than  20  hours. 

Dr.  W.  H.  Blythe  reports  the  case  of  a  man  who  had  been  in- 
jured in  the  chest  by  the  handles  of  a  truck.  He  could  not  turn  over 
for  pain.  He  was  given  bryonin  gr.  1-67  every  two  hours,  and  after 
taking  17  doses  was  able  to  leave  his  bed. 

BUTYL  CHLORAL  HYDRATE. 

Standard  granule — Gr.   1-6,  gm.  .01. 

Butyl  chloral  hydrate,  formerly  known  as  croton  chloral,  is  a 
remedy  with  but  one  clear  cut  and  distinct  indication.  It  was  in- 
troduced by  Liebreich  as  a  remedy  for  painful  affections  of  the 
trigeminal  nerve.  This  property  is  denied  by  von  Mering,  who,  with 
Cushny  and  Wood,  consider  it  does  not  materially  differ  in  action 
from  the  ordinary  chloral  hydrate.  But  Hare  states  that  it  is  more 
analgesic  and  less  depressant  to  the  heart  and  circulation,  and  better 
for  insomnia  due  to  pain.  It  is  quite  effective  in  facial  neuralgias 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


BUTYL  CHLORAL  HYDRATE.         97 

and  migraine,  especially  if  the  fifth  nerve  is  affected ;  also  for  head- 
aches due  to  eyestrain,  sick  headaches  not  dependent  on  disorder 
of  the  stomach  or  on  nervous  debility ;  and  while  useless  in  tooth- 
ache is  beneficial  in  neuralgias  dependent  on  decaying  teeth — a  very 
nice  point  in  diagnosis ! 

Liebreich  found  toxic  doses  cause  deep  sleep,  trigeminal  anes- 
thesia and  stop  the  respiration,  the  circulation  continuing.  Von 
Mering  found  it  lessen  the  blood-pressure. 

Butyl  chloral  relieves  the  pangs  of  tic  douloureux  with  striking 
quickness.  The  dose  required  to  relieve  pain  is  smaller  than  that 
necessary  to  produce  sleep.  The  sleep  is  short  as  compared  with 
that  due  to  chloral  hydrate.  Complete  trigeminal  anesthesia  requires 
doses  of  thirty  to  sixty  grains;  by  which  the  corneal  reflex  is 
abolished,  and  yet  the  spinal  cord  is  unaffected,  as  the  reflexes  of  the 
trunk  and  extremities  and  the  muscular  tonicity  are  normal,' as  well 
as  the  pulse  and  respiration. 

Bronchial  irritability  is  relieved  by  butyl  chloral,  and  Shoemaker 
speaks  of  it  as  assuaging  the  pains  of  dysmenorrhea. 

Dentists  administer  this  agent  to  allay  the  suffering  from  inflam- 
mation of  the  pulp  or  the  peridental  membrane,  or  of  a  recent  filling 
that  is  making  itself  disliked.  Mixed  with  equal  parts  of  menthol 
and  carbolic  acid,  it  is  applied  on  cotton  to  carious  cavities,  the 
mouth  in  all  cases  being  washed  first  with  sodium  carbonate  solu- 
tion. 

Butyl  chloral  is  but  slightly  soluble,  in  water  100  parts,  in  4  of 
glycerin,  in  alcohol,  ether  or  hot  water. 

For  over-doses  the  antidote  is  strychnine  in  doses  sufficient  to 
excite  the  spinal  cord.  Per  contra,  butyl  chloral  is>  an  efficient  anti- 
dote in  strychnine  poisoning. 

The  dose  as  an  analgesic  is  usually  given  as  gr.  iij  to  v,  every  two 
hours ;  as  a  hypnotic  gr.  xv  to  xx ;  but  excellent  results  are  obtained 
from  a  grain  every  quarter-hour.  The  powder  is  irritant  to  the 
stomach.  Brunton  recommended  administration  in  syrup  of  tolu 
or  in  almond  mixture.  Another  mixture  is  butyl  chloral  5  to  10 
parts,  glycerin  and  alcohol  each  20  parts,  distilled  water  100  parts. 

This  is  a  safe  and  effective  anodyne  and  hypnotic  for  little  chil- 
dren, who  can  take  a  granule  containing  gr.  1-6  repeated  at  very 
short  intervals.  It  is  somewhat  difficult  to  distinguish  the  varieties 
of  headache  that  are  amenable  to  butyl  chloral,  but  in  general  those 
due  to  eye-strain  and  when  the  pain  seems  to  be  confined  to  the 
scalp,  are  relieved  by  this  agent  with  remarkable  quickness. 


98  CACTIN 

Von  Mering's  conclusions  were  derived  from  experiments  upon 
animals  in  a  state  of  health;  and,  as  Binz  remarks,  these  negative 
results  prove  absolutely  nothing  against  the  positive  ones  obtained 
by  clinical  trials  with  human  beings  when  ill. 

Yeo  administered  butyl  chloral  with  success  in  nervous  and 
spasmodic  coughs,  and  Nicholson  found  it  effective  against  whoop- 
ing-cough. 

Butyl  chloral  has  been  used  with  advantage  to  anesthetize  the 
eye  or  the  face  before  operations  on  these  regions. 

Van  Renterghem  gives  ten  granules  repeated  every  ten  minutes 
for  tic  douloureux;  for  insomnia  triple  this  dose,  continued  till 
effect.  In  tooth-ache  he  has  succeeded  by  introducing  a  granule  in 
the  cavity  of  the  aching  tooth,  repeating  two  or  three  times. 

CACTIN. 

Standard  granule — Gr.  1-67. 

Cactin  is  a  glucoside,  the  active  principle  of  Cactus  grandi- 
florus,  the  night-blooming  Cereus  of  the  garden.  It  shares  a  posi- 
tion with  digitalin,  strophanthin,  convallamarin  and  adonidin  as  a 
reliable  heart  stimulant.  Its  efficacy  is  most  apparent  in  cases  where 
medication  has  to  be  continued  for  a  prolonged  period ;  it  also  acts 
often  after  all  other  remedies  have  failed.  The  dose  is  two  of  the 
standard  granules  (gr.  1-67)  every  three  to  four  hours.  In  mild 
cases  of  heart  weakness  where  slight  stimulative  and  "supportive" 
action  is  required  one  granule  may  be  given  three  times  daily  for 
months  and  with  marked  advantage. 

Cactin  "increases  the  musculo-motor  energy  of  the  heart, 
elevates  arterial  tension  and  increases  the  height  and  force  of  the 
pulse  wave"  (Ellingwood).  This  describes  its  action  perfectly. 
The  vaso-motor  centers  are  stimulated  and  thus  general  nerve  tone 
is  improved.  Cactin  has  a  distinct  influence  over  the  sympathetic; 
it  aids  markedly  in  restoring  nerve  equilibrium  in  all  neuroses,  and 
as  we  frequently  meet  heart  and  nerve  disorders  conjointly,  the  util- 
ity of  the  remedy  becomes  apparent.  It  acts  positively  upon  the 
heart  muscle  and  also  increases  its  nutrition.  After  a  week  or  two 
of  its  use  valvular  murmurs  become  less  apparent  and,  if  the  drug 
is  continued,  cease. 

Therapeutics. — Cactin  is  indicated  in  all  weakened  conditions  of 
.the  heart  muscle,  in  valvular  inefficiency  and  in  all  cases  with  ir- 
regular and  intermittent  pulse,  Its  action  upon  the  heart  muscle  is 


CAFFEINE  99 

permanent  and  for  general  trustworthiness  and  utility  it  is  hard  to 
name  a  remedy  of  the  class  which  equals  it.  In  neurasthenia  with 
strychnine  or  zinc  phosphide,  cactin  will  give  excellent  results;  in 
nervous  excitement  and  hysteria  with  headache  at  top  of  head  it  is 
always  useful.  It  has  been  recommended  in  impotence  in  conjunc- 
tion with  cornin  and  strychnine  and  phosphorus  and  marked  im- 
provement has  followed  its  use  in  such  cases.  In  endocarditis  and 
pericarditis  it  has  been  used  with  success  and  in  the  feeble  heart 
action  of  pneumonia  and  other  acute  diseases  it  acts  with  certainty 
and  promptness.  One  granule  with  gr.  1-67  of  strychnine  will,  if 
given  every  four  hours,  sustain  the  heart  through  the  most  trying 
periods. 

CAFFEINE. 

Standard  granules — Caffeine  alk.,  gr.  1-67,  gm.  .001 ;  caffeine  alk.,  gr.  1-6, 
gm.  .01 ;  caffeine  arsenate,  gr.  1-67,  gm.  .001;  caffeine  benzoate,  gr.  1-67,  gm. 
.001 ;  caffeine  benzoate,  gr.  1-6,  gm.  .01 ;  caffeine  citrate,  gr.  1-6,  gm.  .01 ; 
caffeine  valerianate,  gr.  1-67,  gm.  .001. 

Caffeine  has  been  found  in  the  coffee  of  Arabia  (Caffea 
Arabica),  the  tea  of  China  (Thea  Chineasis),  the  chocolate  of 
Mexico  (Theobroma  Cacao),  the  guarana  of  Brazil  (Paullinia 
Sorbilis'),  the  mate  of  Paraguay  (Ilex  Paraguayeasis),  the  kola  of 
Africa  (Cola  Acumimata),  and  the  yopon  or  Appalachee  tea  of  the 
Carolinas  (Ilex  Cassine).  All  these  plants  and  no  others  contain 
caffeine;  all  these,  out  of  the  myriads  of  plants  produced  by  the 
earth,  have  been  selected  by  the  natives  of  these  countries  for  use  in 
hot  beverages. 

Is  this  simply  chance?  Or  is  it  to  be  taken  as  showing  that  in 
caffeine  there  is  some  remarkable  fitness  to  meet  some  unknown 
need  of  the  human  economy,  some  want  unrecognized  but  never- 
theless real,  felt  alike  by  these  various  races  and  by  all  mankind, 
savage,  barbarous  and  civilized,  in  torrid,  temperate  and  frigid 
zones,  by  the  sea,  on  the  sea  and  in  the  mountains  ? 

The  caffeine  used  in  medicine  is  obtained  from  tea  leaves  by 
sublimation,  or  by  inspissation  of  the  extract  with  alcohol,  the  tannic 
compound  being  first  broken  up  by  lead  acetate.  Chemically  caffeine 
is  trimethylxanthine.  It  has  been  formed  synthetically.  It  is  a 
weak  base  chemically,  crystallizing  in  white,  lustrous,  flexible  nee- 
dles, soluble  in  80  parts  of  cold  and  2  of  hot  water,  50  parts  of 
alcohol,  9  of  chloroform,  sparingly  in  ether.  It  is  somewhat  bitter. 
With  strong  mineral  acids  it  forms  easily  decomposable  salts.  It 


100  CAFFEINE 

does  not  form  salts  with  organic  acids  and  may  be  volatilized  as 
caffeine  from  their  mixtures.  But  with  organic  acid  and  soda  salts, 
such  as  sodium  benzoate  or  salicylate,  caffeine  forms  double  salts 
which  are  very  soluble  in  water. 

On  frogs  caffeine  causes  contraction  with  stiffness  of  the 
muscles,  especially  evident  when  a  muscle  is  dissected  out  and  im- 
mersed in  caffeine  solution,  or  when  the  latter  is  injected  into  the 
substance  of  the  muscle.  This  is  due  to  direct  action  on  the  muscle 
by  increasing  the  fibrin  ferment.  All  xanthine  derivatives  possess 
this  power,  which  is  weaker  when  the  methyl  group  is  associated, 
as*  in  theobromine  and  caffeine.  The  frog's  heart  resists  the  caffeine 
effect,  continuing  its  rhythm  after  the  striated  muscles  have  stiffened 
tetanically. 

Administered  to  warm-blooded  animals  in  non-toxic  doses,  reflex 
irritability  is  increased,  the  animal  starts  at  every  touch,  and  be- 
comes tetanic  at  times  even  without  evident  cause.  Small  doses  in- 
crease the  pulse-rate ;  larger  doses  render  it  irregular  and  slower  till 
the  heart  stops  in  diastole.  This  is  due  to  a  direct  stimulation  of  the 
cardiac  accelerator  apparatus  and  not  to  paralysis  of  inhibition,  for 
under  atropine  the  same  effect  is  manifested. 

Small  doses  increase  vascular  tension,  larger  ones  depress  it. 
The  former  effect  is  due  to  direct  excitation  of  the  heart  and  of  the 
vasomotor  center,  contracting  the  peripheral  arteries. 

Respiration  is  quickened  at  first,  inspirations  becoming  deeper ; 
later  it  becomes  slower.  This  action  resembles  that  of  strychnine. 
ij)  "The  temperature  rises  about  one  degree  F.  after  medium  doses, 
and  between  two  or  three  degrees  after  toxic  doses.  This  is  doubt- 
less due  to  the  muscular  stimulation  and  increased  vasomotor  ten- 
sion. 

No  effect  upon  peripheral  nerves,  motor,  or  sensory,  has  been 
Idofcermined  after  caffeine  was  administered  internally  in  ordinary 
idoses;  but  steeping  a  motor  nerve  in  caffeine  solution  or  injecting 
the  latter  around  a  sensory  nerve  produces  rapid  paralysis  of  func- 
tion. 

The  lethal  dose  of  caffeine  for  dogs  is  about  1-5000  of  the 
animal's  weight.  Cats  require  double  this  dose. 

The  action  of  caffeine  on  the  kidneys  is  complicated.  The  urine 
is  lessened  in  quantity  by  contracting  the  renal  arteries,  when  large 
doses  are  given.  Small  doses  appear  rather  to  stimulate  the  heart 
and  increase  the  flow  of  urine.  If  the  irritability  of  the  nerves  is 
lessened  by  chloral  or  paraldehyde,  preventing  the  vasomotor  ten- 


CAFFEINE  101 

sion,  caffeine  increases  the  excretion  of  urine.  Liebreich  credits  this 
to  direct  irritation  of  the  renal  epithelium. 

Metabolism  is  little  affected.  The  excretion  of  urea  and  carbonic 
acid  is  increased  by  the  stimulation  of  muscular  contraction.  No 
material  changes  of  the  blood  have  been  noted. 

In  man  small  doses  up  to  o.i  (gr.  \l/2)  slow  the  pulse  some- 
what. Larger  doses  cause  toxic  symptoms,  tinnitus  aurium,  tremor 
of  the  hands,  temporal  pulsation,  headache,  flashes,  vertigo,  in- 
somnia, mental  confusion  or  delirium,  amblyopia  and  transient  deaf- 
ness, palpitation  of  the  heart,  rapid  pulse,  irregular  heart-action, 
and  a  sense  of  oppression  in  the  chest,  some  cases  present  erections, 
strangury,  dysuria,  anesthesia  of  the  throat  and  tongue,  with  swell- 
ing and  muscular  stiffening  up  to  the  production  of  tetanoid  spasms. 
Sometimes  alarming  heart-symptoms  follow,  even  after  small  doses, 
especially  in  myocarditis.  There  are  no  cumulative  effects,  but 
idiosyncrasies  against  caffeine  may  exist.  Larger  doses  are  well 
borne  by  those  accustomed  to  the  drug.  In  any  case,  the  alarming 
symptoms  quickly  subside,  the  caffeine  being  rapidly  eliminated  by 
the  kidneys  and  liver  or  broken  up  in  the  body. 

Caffeine  is  readily  absorbed  by  all  the  mucosa  and  by  the 
cellular  tissues.  Urea  may  be  split  off.  from  caffeine,  as  the  excre- 
tion of  the  former  is  increased  while  taking  caffeine.  The  latter  is 
found  in  large  part  unchanged  in  the  urine,  and  as  monomethyl- 
xanthine. 

Experimenting  on  healthy  men  it  is  necessary  to  give  doses  of 
at  least  five  grains  to  obtain  appreciable  results,  allowing  for 
idiosyncrasies,  and  possibly,  for  the  habitual  use  of  coffee  and  the 
consequent  resistance.  Kelp  gave  eight  grains  to  a  nervous  woman, 
with  toxic  effects  disappearing  within  24  hours ;  such  as  vertigo, 
sense  of  general  fatigue,  precordial  anxiety,  rapid  pulse,  abdominal 
pulsation,  followed  by  trembling  of  the  extremities,  grinding  of  the 
teeth,  later  by  heaviness  of  the  head,  and  spasmodic  contractions  of 
the  muscles  of  the  neck  and  nucha. 

But  Frerichs,  after  taking  a  dose  of  30  grains,  felt  only  heaviness 
of  the  head,  congestion  of  the  brain,  and  vomiting,  quickly  followed 
by  disappearance  of  the  other  symptoms.  It  is  probable  that  the 
whole  of  this  dose  had  not  been  absorbed. 

Men  may  accustom  themselves  to  ascending  doses  of  caffeine; 
and  the  gravest  symptoms  of  over-doses  soon  disappear. 

Caffeine  stimulates  the  striated  muscular  fiber,  which  explains 


102  CAFFEINE 

the  imperious  need  of  emptying  the  bladder  after  drinking  coffee, 
and  why  coffee  removes  the  sense  of  fatigue  after  long  marches. 

Caffeine  penetrates  the  organism  rapidly,  its  effects  are  evanes- 
cent, its  elimination  rapid,  by  the  bile  and  the  urine. 

Leblond,  studying  a  hernia,  found  that  caffeine  augmented  the 
muscular  contractility  of  the  intestine.  Hannon  and  Peretti  found 
it  excited  the  intestinal  secretions  and  even  caused  diarrhea.  Leven 
and  others  credited  it  with  favoring  the  secretions  of  saliva  and  of 
bile.  Gubler  and  others  found  it  provoked  an  abundant  diuresis. 

Small  doses  augment,  toxic  doses  paralyze,  respiration. 

The  pulse  is  lessened  in  frequency,  increased  in  power;  the 
blood-pressure  raised  by  vasomotor  contraction ;  and  toxic  doses 
cause  the  pressure  to  fall  rapidly. 

The  observations  on  the  body  heat  are  contradictory,  some 
testifying  to  a  rise,  others  to  a  fall.  Caffeine  is  a  powerful  stimu- 
lant to  metabolism,  and  when  the  temperature  is  subnormal  from 
deficiency  of  this  function,  caffeine  will  raise  the  heat  to  the  normal 
point.  This  action  I  have  frequently  seen  in  studying  persons  who 
had  discontinued  the  use  of  morphine.  In  a  few  months  there  is 
a  notable  fall  of  temperature,  with  oppression  of  the  chest,  and 
various  unpleasant  subjective  sensations,  which  are  relieved  by 
quickly  flushing  the  emunctories  and  giving  caffeine.  So  also  when 
the  temperature  has  been  depressed  by  exposure  to  cold,  coffee  will 
raise  it  to  the  normal  point  more  quickly  than  the  same  quantity  of 
hot  water  alone.  But  in  fevers  the  same  agent  will  not  elevate  the 
body  heat,  but  even  lowers  it  sensibly. 

The  effect  on  urea  is  obscure.  The  excretion  is  lessened,  but 
this  is  probably  due  to  the  conservation  of  tissue,  lessening  waste. 
Lehmann  and  Froehlich  claim  that  caffeine  retards  the  decom- 
position of  organic  elements.  Voit  denied  this,  and  declared  that 
it  does  not  modify  the  excretion  of  urea.  Roux  found  that  in  his 
own  case  it  increased  the  excretion  of  urinary  solids,  especially  urea 
and  chlorides,  but  on  the  establishment  of  the  "coffee  habit"  the  ex- 
cretion returned  to  the  normal.  But  Binz  wisely  remarks  that  the 
elevation  of  temperature  contradicts  the  diminished  excretion  of 
urea.  Caffeine  must  increase  the  loss  of  urea  and  of  carbonic  acid. 
Nothnagel  says  the  metabolism  (organic  exchanges)  is  not  notably 
influenced  by  caffeine;  and  as  applied  to  healthy  men  this  is  prob- 
ably correct. 

Burggraeve  said:  "It  is  certain  that  caffeine,  like  the  alkaloids 
in  general,  hinders  combustion.  This  is  especially  the  case  with 


^HERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


CAFFEINE  103 

caffeine  arsenate.  We  know  how  rapidly  fever  emaciates,  and  how 
soon  fever  falls  after  a  dose  of  black  coffee.  When  quinine  has  been 
scarce,  intermittents  were  broken  by  coffee.  Whence  this  fever? 
An  exaggerated  combustion,  an  elevation  beyond  measure  of  the 
animal  caloric,  greater  when  the  fever  presented  marks  of  malignity 
or  ataxia.  We  ourselves  tried  it,  being  heated,  the  body  deranged, 
bile  lessened,  when  caffeine  arsenate  rapidly  reestablished  this  secre- 
tion and  lessened  the  uric  acid  in  the  urine. 

"A  boy  with  a  wounded  knee  had  fever  of  40  C.,  ataxia,  pulse 
130,  odor  of  mice,  urine  scanty  and  loaded  with  urates,  exaggerated 
combustion  and  visible  wasting.  The  urine  contained  3.4  per  cent 
of  urea.  Thirst  being  normal  he  drank  only  the  usual  quantity  of 
liquids,  and  took  four  daily  doses  of  caffeine  arsenate,  three  gran- 
ules each.  From  the  first  day  the  effect  on  calorification  was  mani- 
fest, fever  fell,  the  skin  and  tongue  became  moist.  The  bowels 
opened  more  freely,  and  in  three  days  the  improvement  was  notable. 
Veratrine  was  given  for  the  accesses  of  fever  due  to  the  wound, 
these  medicaments  not  excluding  each  other.  The  urea  fell  to  1.4 
per  cent. 

"Urea  is  a  sort  of  cinder.  In  fever  the  operations  of  nature  are 
simply  accelerated,  the  denutritive  combustion  augmented,  more 
cinders  produced,  and  the  kidneys  cannot  eliminate  them  fast 
enough.  Wre  arouse  the  vasomotor  nervous  system  from  torpor  by 
the  alkaloids  and  retard  combustion  by  the  arsenates." 

Synergists  of  caffeine  are,  theobromine,  strychnine,  quinine,  and 
in  some  respects  digitalin  and  the  arsenates. 

Morphine  antagonizes  caffeine,  but  when  the  latter  is  given  as 
Burggraeve  advises,  morphine  may  be  added  to  prevent  or  relieve 
insomnia,  without  interfering  with  the  action  desired. 

Liebreich  recommended  caffeine  in  fevers  with  weak  heart,  es- 
pecially in  oedema  of  the  lungs,  as  a  heart-tonic  and  diuretic ;  also  in 
renal  and  cardiac  dropsies.  In  valvular  affections  he  preferred 
digitalin  and  strophanthin.  But  when  the  heart-muscle  no  longer 
responds  to  the  usual  stimulants  caffeine  may  be  given  with  ad- 
vantage. This  applies  as  well  to  the  treatment  of  renal  diseases. 

Zenetz  dissents  strongly  from  this  use  of  caffeine,  which  he  stig- 
matizes as  treacherous,  deadly  in  large  doses,  from  sudden  stoppage 
of  the  heart  in  systole.  He  found  caffeine  in  the  urine  fifteen  days 
after  its  administration  ceased.  Remedies  should  not  be  repeated 
while  still  in  the  body  and  necessarily  exerting  an  effect.  This 
causes  cumulation.  The  more  the  kidneys  are  diseased,  the  slower 


104  CAFFEINE 

is  the  excretion  of  caffeine.  If  extensive,  any  active  remedy  will 
accumulate.  In  fact  the  task  of  the  day  is  to  ascertain  how  power- 
ful remedies  once  taken  into  the  body  are  going  to  get  out  of  it. 
And  in  this  the  vast  importance  of  kidney-elimination  must  be 
recognized. 

Therapeutics. — In  myocarditis,  functional  heart-diseases,  caffeine 
is  the  appropriate  remedy ;  and  in  all  cases  where  a  quick  and  lasting 
heart-incitation  is  required. 

Headaches  in  chlorotics,  and  hysterics'  migraines,  are  relieved 
by  caffeine.  The  effect  on  neuralgia  is  uncertain. 

In  1864  Botkin  and  Koschlakoff  prescribed  caffeine  in  dropsies, 
and  in  1880  Leech  recommended  it  especially  in  dropsy  attending 
organic  heart-diseases.  Lepine,  Huchard  and  Leblond  followed, 
and  finally  Riegel  ranked  caffeine  with  digitalis.  Based  on  21  cases 
where  caffeine  was  given  alone  or  with  digitalis,  he  deduced  the  fol- 
lowing conclusions : 

1.  Caffeine  shares  with  digitalis  a  regulating  power  over  the 
heart. 

2.  In  proper  doses  caffeine  augments  the  heart's  energy  and  re- 
tards its  action,  increasing  arterial  pressure. 

.      3,     It  quickly  provokes  a  notable  diuresis. 

4.  The  indications  are  the  same  as  for  digitalis. 

5.  The  best  mode  of  administration   is  by  small   doses  often 
repeated. 

6.  It  excels  digitalis  in  an  action  more  rapid  and  non-cumula- 
tive. 

7.  It  can  be  given  with  benefit  where  digitalin  is  inactive. 

8.  The  simultaneous  use  of  narcotics  like  morphine  is  not  to  be 
recommended. 

9.  In  general,  caffeine  is  as  well  and  often  better  tolerated  than 
digitalis.    The  double  salts  of  soda  with  benzoic,  salicylic  and  cin- 
namylic    acids,    are    especially    commendable    from    their    extreme 
solubility  and  facility  for  hypodermic  use. 

But  the  wholesale  condemnation  of  digitalis  is  wrong. 

We  are  often  compelled  to  combine  with  caffeine  and  digitalis, 
strychnine  in  cardiac  insufficiency  with  dyspnea,  or  hyoscyamine  if 
there  is  a  spasmodic  element.  In  fevers  with  rapid  wasting  some 
form  of  arsenic  is  to  be  added,  the  arsenate  of  caffeine  being  eligible. 

Caffeine  has  proved  a  sovereign  remedy  in  certain  forms  of 
headache,  migraine,  hemicrania,  with  throbbing  arteries  (Burg- 
graeve)  ;  those  of  chlorosis,  or  symptomatic  of  hysteria,  and  those 


CAFFEINE  105 

where  there  is  a  general  ache  not  associated  with  hyperesthesia  of 
the  scalp  (Rossbach). 

How  does  it  cure  headache?  We  will  wait,  says  Schmiedeberg, 
till  we  know  the  exact  nature  of  the  malady. 

The  stimulant  effect  of  this  agent  on  the  cerebral  cell  is  shown 
in  cases  of  intellectual  and  nervous  torpor;  in  coma,  somnolence; 
in  the  state  consecutive  to  long  loss  of  sleep,  from  sunstroke,  alcohol 
or  the  abuse  of  narcotics.  In  typhoid  coma,  and  in  the  somnolence 
that  accompanies  the  profound  anemia  of  hemoglobinuria,  caffeine 
arouses  the  brain. 

In  military  service  caffeine  is  of  inestimable  value  in  enabling 
the  soldier  to  endure  long  marches  with  little  food,  that  he  could 
not  possibly  have  endured  without  it.  Strychnine  is  an  aid  here. 
In  removing  the  sense  of  hunger  and  of  fatigue  caffeine  approaches 
cocaine;  in  stimulating  the  nerve-cell  and  the  muscular  fiber  it 
ranks  with  strychnine. 

Burggrseve  called  attention  to  the  value  of  caffeine  in  relieving 
the  accidents  due  to  the  abuse  of  tobacco,  and  to  its  cholagog  power. 
Caffeine  arsenate  neutralizes  the  stupefying  effects  of  tobacco,  and 
relieves  the  asthma,  dyspnea,  dyspepsia,  cerebral  congestion,  and 
intermittent  neuroses,  caused  by  tobacco.  In  catarrhal  and  rheu- 
matismal  jaundice  he  insisted  on  general  baths,  with  mild  laxatives, 
and  recalled  the  secretion  and  discharge  of  bile  by  the  use  of  quassin 
and  caffeine,  esteeming  them  the  best  since  they  cause  no  intestinal 
irritation;  and  as  Liebig  said,  caffeine  augments  the  taurin.  The 
depression  of  the  pulse  does  not  permit  the  other  alkaloids ;  unless 
in  continued  fever  when  veratrine  and  aconitine  are  needed,  espe- 
cially with  cutaneous  hyperesthesia.  In  spasmodic  jaundice  it  is 
atropine  that  is  needed ;  but  if  the  spasm  depends  on  weakness  one 
can  give  strychnine  or  brucine,  alone  or  with  quassin  and  caffeine. 
In  malarial  jaundice  we  must  insist  on  quinine,  with  quassin  and 
caffeine  to  restore  the  bile.  Watch  the  proper  time  and  do  not  force 
the  remedy. 

Olliviers  has  reported  two  cases  where  caffeine  exerted  an 
anthelmintic  action,  in  children. 

Eulenberg  used  caffeine  hypodermically  for  neuralgias. 

The  effect  on  the  contractility  of  the  intestinal  muscles  has  led 
some  to  try  it  in  strangulated  hernia. 

In  continued,  intermittent  and  adynamic  fevers,  several  have 
used  coffee ;  and  others  have  given  it  with  success  in  asthma. 

The  hypodermic  administration  of  caffeine  presents  many  ad- 


106  CAFFEINE 

vantages — in  coma,  narcotic  poisoning,  irritable  conditions  of  the 
stomach,  and  when  the  local  analgesic  effect  is  desired  in  treating 
neuralgias. 

Dosage. — Dujardin-Beaumetz  and  Huchard  have  given  caffeine 
in  doses  up  to  gr.  45,  thrice  daily ;  the  latter  limits  the  useful  dose 
to  1.8  grains.  These  doses  are  toxic  and  are  not  to  be  advised.  Six 
grains  have  produced  toxic  effects,  and  7^/2  grains  occasioned  con- 
vulsions (Sevestre). 

When  we  get  rid  of  the  idea  that  the  proper  dose  is  all  a  patient 
can  take  without  actually  killing  him,  and  learn  to  measure  our 
doses  by  the  effects  to  be  secured,  we  find  that  caffeine  itself  is  best 
given  in  doses  of  a  grain,  singly,  and  up  to  seven  grains  a  day, 
while  the  arsenate  is  most  useful  in  granules  of  gr.  1-67  each,  and 
rarely  more  than  seven  to  ten  of  these  in  24  hours.  The  citrate  of 
caffeine  is  too  uncertain  for  accurate  medication.  The  same  might 
be  said  of  the  valerianate,  but  this  is  the  most  active  diuretic  of  the 
caffeine  salts,  and  in  doses  of  a  grain  has<  proved  on  many  occasions 
its  great  value. 

In  treating  the  subnormal  temperatures  of  men  formerly  mor- 
phine addicts,  the  hypodermic  dose  of  three  grains  once  or  twice  a 
day  was  rarely  exceeded,  and  this  was  not  often  required.  In  fact, 
in  treating  headaches  of  great  intensity,  gr.  1-6  every  ten  minutes 
rarely  fails  to  give  relief  within  an  hour  or  two,  if  this  remedy  is 
indicated.  If  due  to  autotoxemia,  it  may  even  relieve  before  the 
bowel  has  been  emptied  of  its  poisonous  contents,  but  this  is  not 
good  practice. 

As  a  cardiac  tonic,  from  1-6  to  one  grain  should  be  given  every 
hour  till  the  required  tonicity  is  secured ;  and  in  view  of  the  rapid 
excretion  of  caffeine  this  is  better  than  less  frequent  larger  doses. 

In  wasting  fevers  Van  Renterghem  recommends  the  arsenate  up 
to  20  granules  a  day,  each  gr.  1-67.  In  prolonged  deprivations  of 
sleep  it  is  of  the  utmost  importance  to  give  just  enough  and  not  any 
more ;  so  that  the  little  doses  frequently  repeated  as  per  the  need  are 
excellently  calculated.  So  also  for  soldiers  on  the  march ;  use  just 
enough  and  no  more,  and  good  will  result ;  give  too  much,  exhaust- 
ing the  susceptibility  of  the  system  and  disappointment  must  ensue. 

In  nicotism  Burggraeve  recommended  the  arsenate,  ten  to  twenty 
granules  a  day,  the  patient  moderating  or  ceasing  the  use  of  tobacco. 

Liebreich  gives  the  dose  of  caffeine  in  hemicrania  as  o.i  to  0.2 
(gr.  1 1/2  to  3),  in  heart-weakness  as  0.05  to  o.i  (gr.  5-6  to 


CAFFEINE  107 

every  hour  or  two;  and  0.6  to  0.8  (gr.  9  to  12)  as  a  daily  dose.  It 
may  be  given  in  wafers,  pills*  or  pastilles. 

When  giving  caffeine  to  young  persons  showing  nervous  irrita- 
bility, it  is  best  to  administer  the  daily  dose  in  the  early  part  of  the 
clay  to  avoid  insomnia. 

The  daily  maximum  dose  is  variously  stated  by  European  phar- 
macopoeias as  0.5  to  1.5  (gr.  714  to  23). 

For  hypodermic  use  the  double  salts  are  preferable  on  account 
of  their  great  solubility.  Of  caffeine  alkaloids — 

The    caffeine-soda  benzoate      contains  46  per  cent 

"      cinnamylate      "  62.5  " 

"      salicylate  "  62.5  "    .   " 

"      hydrochlorate   "  52  "       " 

The  salicylate  may  be  prepared  easily  by  taking  35  grains  sodium 
salicylate,  40  grains  caffeine,  and  distilled  water  to  make  two  drams, 
of  which  three  minims  contain  one  grain  of  caffeine.  For  hypo- 
dermic use  this  should  be  made  with  chemically  pure  sodium  salicy- 
late ;  that  of  Schering  being  the  only  one  I  have  found  that  gave  a 
colorless,  unirritant  solution.  This  should  be  injected  the  moment 
it  is  taken  up  in  the  syringe,  or  the  metal  of  the  needle  will  be  acted 
upon  and  will  contaminate  the  solution.  The  syringe  should  be 
washed  at  once  after  being  used. 

Caffeine-sulphuric  acid  forms  salts  that  are  said  to  have  no 
vasomotor  tensor  power  whatever,  while  they  exert  the  diuretic 
properties  of  caffeine  to  the  fullest  extent.  The  sodium,  lithium  and 
strontium  caffeine  sulphonates  are  known  as  symphords.  They  are 
soluble  in  cold,  more  rapidly  in  hot  water;  the  solutions  are  not 
permanent.  They  have  proved  efficient  diuretics  in  dropsy,  obesity 
and  fatty  heart,  in  doses  of  4.0  to  5.0  (gr.  60  to  75)  per  diem. 

Bromo-caffeine,  C8  H9  Br  N4  O2,  is  produced  by  treating  caf- 
feine with  bromine  at  a  slowly  rising  temperature. 

Ethoxy-caffeine  Cs  H9  (OC3  H,)  N4  O2.  The  introduction  of. 
the  ethoxyl  group  adds  to  the  cardio-vascular  tensor  effect  of  caf- 
feine a  narcotic  property.  It  has  been  given  in  doses  of  0.2  to  i.o 
(gr.  3  to  15),  in  hemicrania  and  trigeminal  neuralgia.  Collapse 
with  vomiting  followed  closes  of  0.5  (gr.  7^).  It  must  be  given 
therefore  with  caution. 


108  CALCIUM  CARBONATE 

CALCIUM    CARBONATE. 

(  CALCALITH — ABBOTT. ) 
Standard  tablet — Gr.  10,  gm.  .6. 

Calcium  carbonate  is  too  abundant  in  nature  to  require  descrip- 
tion. Its  principal  employment  in  medicine  is  as  a  remedy  for  the 
uric-acid  diathesis,  and  when  so  used  should  be  in  the  c.  p.  form. 
A  few  sentences  of  introduction  are  therefore  necessary : 

We  know  essentially  nothing  positive  in  regard  to  the  real  pri- 
mary cause  of  the  uric-acid  diathesis,  but  it  is  clear  that  any  at- 
tempt to  remove  the  consequences  of  this  uric-acid  accumulation  must 
be  directed  (i)  towards  removing  the  excessive  uric  acid  from  the 
blood  and  tissues,  (2)  towards  preventing  the  deposits  of  crystal- 
line urates,  and  (3)  towards  attempting  to  re-dissolve  these  con- 
cretions after  they  have  once  formed.  This  brings  us  to  the 
fundamental  therapeutic  question  that  has  agitated  physicians  for 
over  a  century,  namely,  "What  can  we  do  to  dissolve  uric  acid  after 
it  has  been  deposited  and  what  can  we  do  to  hold  it  in  solution  so 
that  it  will  not  be  deposited  or  redeposited  ?" 

There  are  a  great  many  so-called  "uric-acid  solvents,"  the  lead- 
ing ones  being  alkalies,  the  salts  of  lithium,  colchicum,  lysidin  and 
uricedin.  Now,  as  a  matter  of  fact  all  that  we  know  about  these 
different  bodies  is  that  they  possess  the  power  of  dissolving  uric 
acid  in  a  test  tube,  that  is,  outside  of  the  body,  and  it  is  exceedingly 
questionable  whether  they  possess  the  same  power  when  circulat- 
ing in  the  blood  and  tissue  fluids.  It  seems  hardly  possible  that 
they  should  be  able  to  perform  this  function,  for,  when  we  admin- 
ister a  few  grains  by  mouth,  very  little  of  these  different  bodies 
ever  reaches  the  uric-acid  deposits.  One  might  as  well  expect  to 
reduce  obesity  by  administering  small  quantities  of  ether  on  the 
ground  that  ether  is  capable  of  dissolving  fat  outside  of  the  body, 
or  expect  to  dissolve  the  lime  salts  in  osteophytes  or  calcareous 
tubercles  by  the  administration  of  mineral  acids,  on  the  ground 
that  these  will  dissolve  lime  salts  in  a  test-tube. 

There  is  finally  another  fallacy  about  all  this  (and  this  applies 
particularly  to  the  administration  of  small  quantities  of  lithium 
salts),  the  lithium  carbonate  never  enters  the  bood  as  a  carbonate 
but  as  a  chloride,  for  as  soon  as  it  reaches  the  stomach  the  hy- 
drochloric acid  liberates  the  carbonic  acid  and  forms  lithium  chloride 
and  the  latter  is  not  an  active  uric-acid  solvent. 

The  uric  acid  in  the  blood  combines  only  to  a  very  slight  degree 


THERAPEUTIC   NOTES 


THERAPEUTIC    NOTES 


CALCIUM  CARBONATE  109 

with  the  lithium;  the  bulk  of  it  is  bound  to  remain  in  solution  in 
combination  with  other  stronger  bases  like  sodium  and  potassium 
that  are  always  present. 

That  all  this  is  true,  can  be  demonstrated  by  a  very  simple  ex- 
periment: If  we  give  a  small  quantity  of  lithium  carbonate  by  the 
mouth  it  appears  almost  quantitatively  in  the  urine  within  a  short 
time,  not,  however,  in  the  form  of  lithium  urate  but  as  lithium 
chloride.  We  see,  then,  the  ordinary  treatment  of  the  uric-acid 
diathesis  by  so-called  uric-acid  solvents  is  based  on  a  number  of  fal- 
lacies and  inconsistencies;  in  fact,  to  this  time  it  has  been  largely 
shrouded  in  empiricism. 

The  question  is,  what  can  we  do?  And  the  answer  is  given  in 
the  following  arguments :  We  must  first  determine  what  factors 
are  operative  to  keep  the  uric  acid  in  solution  and  we  must  then 
attempt  to  enforce  these  factors.  This  point  has  been  made  the 
subject  of  an  exhaustive  investigation  by  Dr.  A.  C.  Croftan  of 
Chicago,  and  we  cannot  do  better  than  quote  in  extenso  from  the 
Doctor's  article,  which  appeared  in  a  recent  issue  of  the  Journal  of 
the  American  Medical  Association.  Dr.  Croftan  in  this  paper  ex- 
plains how  the  sodium  salts  of  phosphoric  acid  are  concerned  in 
keeping  the  uric  acid  in  solution;  how  one  series  of  these  salts  (the 
basic  salts)  dissolve  the  uric  acid  with  the  greatest  facility, 
whereas  another  series  (the  acid  salts)  have  a  tendency  to  precipi- 
tate it.  He  puts  it  as  follows: 

"Phosphoric  acid  forms  three  salts  with  sodium,  namely: 
H3?O4,  phosphoric  acid; 
NaH2PO4,  mono-sodium  phosphate; 
Na2HPO-4,  di-sodium  phosphate; 
Na3PO4,  tri-sodium  phosphate. 

"The  mono-  and  the  di-sodium  phosphate  normally  occur  in  the 
urine.  Uric  acid  is  readily  soluble  in  di-sodium  phosphate,  but  it  is 
not  soluble  in  mono-sodium  phosphate.  The  addition,  in  fact,  of 
mono-sodium  phosphate  to  a  solution  of  uric  acid  in  di-sodium  phos- 
phate will  cause  the  precipitation  of  the  uric  acid. 

"It  is  clear,  therefore,  that  the  solubility  of  uric  acid  in  the  urine 
is  enhanced  by  the  presence  of  di-sodium  phosphate  and  that  the 
tendency  to  the  formation  of  uric-acid  concretions  increases  in  pro- 
portion to  the  amount  of  mono-sodium  phosphate  that  is  excreted 
through  the  kidneys. 

"It  is  also  clear  that  any  endeavor  directed  toward  preventing 
the  precipitation  of  uric  acid  in  the  urinary  passages  must  be  con- 


110  CALCIUM  CARBONATE 

cerned  with  increasing  the  amount  of  di-sodium  phosphate  and 
decreasing  the  amount  of  mono-sodium  phosphate. 

"The  ideal  would  be  to  cause  the  complete  disappearance  from 
the  urine  of  mono-phosphate  and  at  the  same  time  to  produce  the 
elimination  through  the  kidneys  of  a  quantity  of  di-phosphate  suf- 
ficiently large  to  hold  all  the  uric  acid  excreted  in  solution. 

"The  regulation  of  the  phosphoric-acid  content  of  the  blood  can 
be  achieved  by  the  administration  of  calcium  salts.  For,  in  the 
first  place,  calcium  forms  insoluble  salts  with  the  alkaline  phos- 
phates contained  in  our  normal  food,  and  in  this  way  prevents  the 
absorption  of  this  moiety  into  the  blood.  In  the  second  place,  cal- 
cium, owing  to  the  great  affinity  it  possesses  for  phosphoric  acid, 
combines  with  the  phosphoric  acid  encountered  in  the  blood-stream, 
and  is  subsequently  eliminated  in  the  form  of  calcium  phosphate — • 
not,  however,  through  the  kidneys,  but  in  great  part  through  the 
intestine.  This  is  an  important  .point,  for  in  contradistinction  to 
sodium,  potassium  and  magnesium,  all  elements  that  are  chiefly 
eliminated  through  the  kidneys,  85  to  95  per  cent  of  calcium  is  elim- 
inated through  the  bowel. 

"It  will  be  seen,  therefore,  that  calcium  given  by  mouth  will, 
first,  prevent  the  entrance  of  preformed  phosphoric  acid  (phos- 
phates) from  the  food  in  the  blood,  and,  secondly,  will  prevent  the 
phosphoric  acid  formed  in  the  organism  from  passing  into  the  urine 
by  causing  its  elimination  through  the  intestine." 

One  might  ask  if  the  salts  of  sodium,  or  potassium,  which  are 
also  capable  of  forming  basic  phosphates  in  the  blood,  might  not 
answer  the  purpose  just  as  well  as  calcium?  But,  as  Dr.  Croftan 
clearly  brings  out  in  his  article,  there  are  certain  objections  to  the 
use  of  the  sodium  salts.  In  the  first  place,  the  sodium  phosphate, 
in  contradistinction  to  the  calcium  phosphate,  is  excreted  through 
the  kidneys  and  not  through  the  bowels  so  that  only  very  little  would 
be  gained  by  the  administration  of  these  sodium  salts,  unless  so 
much  were  given  that  the  gastric  function  would  be  seriously  in- 
jured and  the  other  effects  produced  that  we  know  to  follow  the 
continued  excessive  alkalinization  of  the  blood  and  the  urine.  The 
urine  is  normally  slightly  acid,  and  it  should  be  kept  so,  and  calcium 
salts  given  even  in  considerable  doses  never  render  the  urine  alka- 
line. The  Doctor  summarizes  these  objections  in  the  following 
words : 

"Whereas,  therefore,  the  administration  of  large  doses  of  sodium 
salts  for  long  periods  of  time  may  be  indicated  on  theoretical 


CALCIUM  CARBONATE  ill 

grounds,  it  is  contraindicated  on  empirical  grounds.  First,  because 
it  renders  the  urine  alkaline  and  thus  favors  the  deposit  of  concre- 
tions other  than  uric-acid  stones;  second,  because  it  exercises  a 
deleterious  effect  on  gastric  digestion ;  third,  because  it  is  not  with- 
out effect  on  the  corpuscular  elements  of  the  blood ;  fourth,  because 
it  is  superfluous,  as  calcium  salts,  by  decreasing  the  phosphoric 
acid  of  the  urine,  thereby  cause  a  relative  increase  of  the  sodium 
(and  of  the  sodium  di-phosphate)  without  at  the  same  time  render- 
ing the  urine  alkaline." 

Therapeutics. — Dr.  Croftan  advises  the  administration  of  the 
carbonate  of  calcium  to  be  given  in  ten  to  fifteen  grain  doses  two  or 
three  times  a  day,  together  with  a  full  glass  of  water.  The  results 
obtained  from  this  practice  in  various  manifestations  of  the  uric- 
add  diathesis,  gout,  goutiness,  rheumatism  and  particularly  in 
gravel  and  nephrolithiasis  are  very  gratifying.  The  results  that 
Dr.  Croftan  publishes  in  his  preliminary  note  are  as  follows : 

"I  report  four  cases ;  they  present  no  clinical  features  of  sufficient 
intrinsic  interest  to  merit  chronicling  in  detail.  The  only  noticeable 
fact  is  that  all  four  were  advised  by  me  several  years  ago  to  use  cal- 
cium salts  continuously ;  that  all  four  were  lost  sight  of  for  periods 
varying  from  two  and  a  half  to  four  years,  and  that  all  four  recently 
again  come  under  observation  for  other  causes  without  having  suf- 
fered a  recurrence  of  their  attacks  of  renal  colic  during  the  whole 
intervening  time.  Several  other  cases  I  have  lost  track  of,  but  hope 
to  rediscover. 

"Von  Noorden,  who  first  advocated  the  use  of  calcium  salts  in 
nephrolithiasis,  reports  only  two  recurrences  of  renal  colic  among 
twenty-one  cases ;  in  one  patient  an  attack  occurred  a  few  days  after 
beginning  the  treatment ;  in  another  patient  who  had  suffered  from 
severe  attacks  every  few  weeks,  an  attack  developed  nine  months 
after  the  treatment  was  begun,  and  not  again  thereafter. 

"The  good  results  obtained  in  my  four  cases  and  the  statistics 
of  Von  Noorden  lead  me  to  believe  that  the  treatment  of  uratic 
nephrolithiasis  by  the  continuous  exhibition  of  calcium  salts  is  effi- 
cacious and  deserving  of  extended  trial." 

This  report  has  been  supplemented  by  the  experience  of  many 
physicians  who  verify  these  findings  in  detail.  In  all  diseases  of  the 
uric-acid  type,  calcium  carbonate  (or  its  compound  preparation, 
Calcalith)  has  been  found  efficacious.  Such  are  not  only  rheuma- 
tism and  gout,  but  sick  headaches,  myalgia,  asthma,  hay  fever, 
nephrolithiasis,  urinary  calculi,  eczema  and  other  skin  diseases, 


1 1 2  CALCIUM  IODIZED 

many  nasal  and  throat  troubles  and  a  variety  of  other  affections  of 
this  type. 

It  appears,  therefore,  that  we  have  here  at  least  a  true  physio- 
logical uric-acid  solvent,  and  that,  to  judge  from  the  reports  of  care- 
ful, conservative  and  at  the  same  time  scientific  clinicians,  the  ad- 
ministration of  calcium  salts  is  of  great  value  in  the  treatment  of 
this  class  of  disorders. 

I  have  supplemented  Croftan's  investigations  with  a  sufficient 
experience  to  justify  me,  as  above  in  standing  for  his  find- 
ings. I  would  even  go  further  than  he  does  in  my  claims  for  the 
efficiency  of  this  experiment,  but  in  so  doing  have  added  certain 
synergists  and  prepared  a  c.  p.  calcium  carbonate  which  added  to 
lithium  and  colchicine  makes  in  Calcalith  (Abbott)  a  remedy  which, 
as  an  eliminative,  is  far  superior  to  the  plain  salt,  and  the  value 
of  which  is  untold.  It  is  a  true  uric-acid  solvent,  stimulating  every 
excreting  organ  and  is  applicable  to  every  manifestation  of  the  uric- 
acid  diathesis. 

CALCIUM    IODIZED. 

(CALCIDIN.) 
Standard  tablet — Gr.  1-3,  gm.  .02. 

The  names  "calcium  iodide"  and  "iodide  of  lime"  have  long  been 
known  in  chemistry  and  in  the  schools  of  medicine,  yet  these  names 
are  loosely  used  and  do  not  always  refer  (and  never  properly)  to 
the  remedy  to  which  we  refer.  This  is  an  important  point  and  must 
not  be  lost  sight  of. 

The  "iodide  of  lime,"  so-called,  to  which  we  refer  (properly 
calcium  iodized,  or  iodized  lime,  or  Calcidin,  A.  A.  Co. ) ,  is  not  the 
chemical  crystalline  salt,  Cal2 ;  it  is  not  a  crystalline  body  at  all  and 
does  not  contain  that  definite  molecular  combination  which  that 
chemical  formula  indicates. 

Calcium  iodized  is  an  amorphous  compound  body  or  substance 
containing  a  much  larger  quantity  of  iodine  which  readily  separates 
from  its  loose  combination  with  the  lime,  when  coming  in  contact 
with  acids,  and  thus  lets  the  nascent  iodine  free  to  do  its  absorbing 
and  alterative  work. 

This  salt  and  its  peculiar  and  specific  application  to  the  treatment 
of  true  croup  was  discovered  some  years  ago,  and,  as  it  was  then 
erroneously  called  "iodide  of  lime,"  and  "brown  iodide  of  lime," — 
neither  of  which  it  is — it  attracted  little  attention.  Owing  to  this 


CALCIUM  IODIZED  113 

incongruous  nomenclature  it  was  left  in  its  empiricism,  and  even  the 
few  who  had  learned  to  rely  upon  it  did  not  attempt  to  explain  the 
rationale  of  its  action. 

Physiologic  Action. — While  calcium  is  a  valuable  reconstructive 
it  serves  here  mainly  as  a  base  or  vehicle  for  the  iodine  to  which  we 
must  look  for  the  explanation  of  the  peculiar  therapeutic  activity  of 
the  compound.  The  remedial  power  peculiar  to  iodine  is  to  stimu- 
late to  renewed  vitality  the  absorbent  vessels  of  the  body,  which 
have  become,  either  pathologically  impaired,  or  are  insufficient  in 
their  normal  state,  to  take  up  and  dispose  of  the  adventitious  matter 
which  does  not  belong  to  the  body  normally.  But  the  difficulty  with 
iodine  is,  that  it  cannot  be  given  in  its  purity,  even  in  medicinal 
doses,  -for  any  length  of  time  without  producing  unpleasant  sensa- 
tions in  the  skin,  nose,  throat  and  eyes. 

This,  however,  is  less  the  case  in  children,  who  are  naturally 
more  tolerant  of  this  remedy  and  become  more  and  more  so  under 
treatment,  especially  when  it  is  given  in  the  form  of  an  iodide,  and 
above  all,  when  given  as  iodized  lime,  very  likely  because  lime  is  a 
normal  constituent  of  the  body,  thus  carrying  the  iodine  to  it  in  a 
more  natural  and  readily  assimilable  form.  However  this  may  be, 
the  fact  remains  that  calcium  iodized  does  not  cause  iodism,  even 
when  given  in  maximum  dosage  and  for  a  prolonged  period. 

Therapeutics. — Croup,  that  sudden  scourge  of  infancy  and  child- 
hood, when  it  is  merely  spasmodic,  that  is,  when  the  chink  of  the 
glottis  is  narrowed  by  a  spasmodic  contraction  of  the  muscular  and 
other  fibers  of  the  vocal  cords,  while  amenable  to  and  well  treated 
by  calcium  iodized,  can  usually  be  overcome  by  antispasmodics  with- 
out calcium  iodized.  Of  these,  aconitine,  hyoscyamine  and  apo- 
morphine  are  the  best.  It  is  always  well,  however,  to  include  cal- 
cium iodized,  for  diagnosis  cannot  always  be  sure,  at  first,  between 
the  true  and  the  false. 

For  a  child  up  to  five  or  six  years,  give  about  six  tablets,  gr.  1-3 
each,  or  two  to  three  grains  of  the  powder,  dissolved  in  six  teaspoon- 
fuls  of  water,  a  teaspoon ful  every  five  to  ten  minutes  until  effect,  or 
one  to  three  grains,  dry  on  the  tongue,  following  with  a  draught  of 
water.  If  for  any  reason  this  is  not  efficient,  recourse  should  be 
had  to  apomorphine,  (1-16  to  1-12  gr.),  hypodermically,  attempt- 
ing to  stop  at  nausea,  just  short  of  actual  emesis — unless  the  latter 
be  clearly  indicated.  In  severe  cases  complicated  by  "a  full  stom- 
ach," the  apomorphine  may  be  given  at  once  with  advantage,  Cal- 


114  CALCIUM  IODIZED 

cidin,  Abbott,  being  exhibited  in  smaller  doses  as  soon  as  emesis 
ceases. 

But  the  same  croupy  cough  may  be  caused  by  a  catarrhal  state  of 
the  inside  of  the  larynx,  tumefying  the  vocal  cords,  narrowing  the 
chink  between  the  true  vocal  cords,  thus  producing  that  peculiar 
"crow"  and  a  moderate  amount  of  dyspnea,  which  antispasmodics 
will  not  permanently  relieve.  The  case  may  even  proceed  to  an 
exudation  of  material  capable  of  forming  a  membrane  not  only  on 
the  vocal  cords,  but  on  the  parts  above  and  below  them,  and  the 
danger  of  suffocation  becomes  imminent.  It  may  not  be  easy  in 
such  cases  to  distinguish  between  a  diphtheritic  and  a  simple  croup- 
ous  membrane,  and  while  we  cannot  be  sure  of  the  efficiency  of  this 
remedy  in  the  former — for  the  simple  reason  that  there  we  have  a 
specific  toxin  to  deal  with — we  are  sure  of  it  in  the  latter.  Calcium 
iodized  (Calcidin)  properly  and  persistently  administered  will 
rarely  disappoint,  and  most  .frequently  it  will  surprise  the  physician 
with  the  rapidity  of  its  action. 

The  following  is  the  experience  of  one  physician,  as  related  in 
The  Alkaloidal  Clinic: 

"About  seven  years  ago  I  first  used  calcium  iodized  for  mem- 
branous croup,  since  which  time  all  difficulty  in  curing  every  case 
which  has  fallen  into  my  hands  has  ceased,  and  I  am  firmly  of  the 
opinion  that  nowhere  in  the  domain  of  therapeutics  have  we  a  rem- 
edy more  deserving  of  the  name  'specific.'  During  these  seven  years 
I  have  treated  not  less  than  twenty-five  or  thirty  cases  of  this  fatal 
disorder,  true  croup }  without  a  single  failure  and  without  remaining 
at  the  bedside  of  my  patient  for  a  single  hour.  Under  its  use  the 
symptoms  quickly  improve  and  invariably  disappear,  and  the  patient 
moves  forward  to  an  easy  and  sure  recovery.  The  dread  which  I 
formerly  had  of  this  malady  has  entirely  disappeared  and  I  take 
charge  of  these  cases  with  as  much  assurance  of  recovery  as  though 
the  little  ones  were  suffering  only  with  measles." 

Hundreds  of  similar  reports  are  conclusive  evidence  of  the  value 
of  this  remedy  in  croup. 

It  is  important  that  no  error  in  diagnosis  be  made,  if  satisfactory 
results  are  to  be  obtained  from  the  use  of  the  remedy,  for  while  it  is' 
almost  certain  to  cure  any  case  of  spasmodic  or  membranous  croup 
in  which  it  is  used  within  reasonable  time,  it  possesses  alone  no 
curative  virtues  in  diphtheritic  croup. 

Calcium  iodized  is  also  praised  by  respectable  authorities  as  an 
absorbent  agent  in  cases  of  uterine  fibroids,  when  given  in  small 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


CALCIUM  IODIZED  115 

doses  three  to  four  times  a  day  for  months,  and  even  for  a  year.  It 
is  also  praised  as  a  calmative  remedy  for  the  dyspnea  that  is  likely 
to  arise,  at  night,  especially,  from  heart-disease.  So  also  in  the 
dyspnea  of  consumptives,  and  in  that  of  asthma,  where  it  is  one  of 
the  very  best  remedies  we  possess.  In  fact,  it  may  properly  be  used 
in  all  conditions  where  the  iodine  effect  is  desired;  and  that  it  will 
produce  that  effect  with  less  irritation  and  with  less  expenditure  of 
time  than  any  iodine-carrying  agent  with  which  we  are  familiar, 
the  practician  can  speedily  prove  for  himself  by  trying  it  a  few 
times. 

To  young  infants  with  the  "snuffles,"  whether  due  to  post-nasal 
adenoids,  hypertrophied  turbinates  or  inherited  syphilis,  given  in 
doses  ranging  from  1-2  to  1-3  of  a  grain  three  or  four  times  a  day, 
as  indicated,  it  will  be  found  to  quickly  relieve,  and,  with  removal 
of  cause,  will  soon  effect  a  cure.  In  older  children  with  night  cough, 
due  either  to  catarrh  of  the  naso-pharynx,  or  to  clogging  of  the 
bronchi  in  subacute  or  chronic  bronchitis,  doses  of  one-third  to  one 
grain,  repeated  every  fifteen  minutes  for  a  few  doses  during  the 
paroxysms  will  often  give  relief  when  everything  else  fails. 
Through  its  alterative  action  it  favorably  influences  these  cases 
when  given  continuously  three  or  four  times  a  day. 

After  grippal  attacks,  where  the  bronchial  glands  are  enlarged 
and  there  is  found  upon  examination  of  the  throat,  a  tough,  grayish- 
yellow  secretion  adhering  closely  to  the  folds  of  the  soft  palate 
and  to  the  sides  of  the  pharynx  extending  into  the  vault,  and  in 
which  there  is  a  disagreeable,  dry,  rasping  cough,  calcium  iodized 
in  doses  of  one  or  two  grains,  dissolved  in  water,  and  given  every 
three  or  four  hours,  will  act  promptly  and  afford  relief  sooner  than 
any  other  remedy  yet  tried.  In  all  catarrhal  conditions  of  the  upper 
respiratory  tract  it  should  be  one  of  the  main  remedies. 

In  cases  of  heart-disease  in  which  there  are  nightly  paroxysms 
of  an  intense  feeling  of  oppression  in  the  chest,  with  spasm  of  the 
bronchial  tubes,  suffocation,  dyspnea,  and  an  incessant,  dry,  metallic 
cough,  one  grain  of  calcium  iodized  every  fifteen  minutes  usually 
relieves  by  the  time  the  third  dose  is  taken.  The  remedy  does  not 
influence  either  favorably  or  unfavorably  the  heart  lesion. 

In  the  night  coughs  of  tuberculosis  it  is  an  invaluable  remedy; 
two  or  three  one-grain  doses  repeated  at  half-hour  intervals  just 
before  bedtime  will  usually  cause  the  patient  to  rest  well  until  be- 
tween three  or  four  o'clock  in  the  morning,  when  a  few  more  doses 
repeated  in  the  same  manner  will  bring  him  comfortably  through 


116  CALCIUM  IODIZED 

the  night.  It  lessens  hectic  ,fever,  and  prevents  night-sweats.  It 
may  not,  however,  check  or  retard  the  course  of  the  disease,  when  it 
has  gone  to  this  extent,  but  in  phthisis,  generally,  its  efficiency  is 
practically  proven. 

In  the  so-called  coughs,  due  to  irritation  of  the  uterus,  ovaries 
or  stomach,  it  gives  relief.  In  whooping-cough  in  full  dosage,  one 
granule  after  meals,  it  has  proven  an  excellent  remedy.  Elimination 
should  be  stimulated  in  all  these  instances.  In  this  connection  atten- 
tion may  be  well  called  to  the  undoubted  benefit  derived  from  the 
use  of  calcium  iodized  in  many  cases  of  an  autotoxemic  character. 
When  the  stomach  and  intestinal  walls  are  flabby,  catarrhal  and  lack- 
ing in  tone,  the  administration  (after  a  thorough  eliminative  course 
of  calomel  and  podophyllin,  gr.  1-6  each,  every  two  hours  for  a  day 
or  two)  will  bring  about  a  marked  change  for  the  better. 

Another  point  worthy  of  consideration  here  is  the  value  of  cal- 
cium iodized  in  all  throat  affections  causing  disturbances  of  the 
voice.  Singers'  sore  throat,  "clergyman's  voice,"  etc.,  will  one  and 
all  be  speedily  benefited  by  Calcidin  and  strychnine  arsenate. 

From  the  foregoing  it  becomes  evident  that  in  calcium  iodized 
the  practician  has : 

1.  An  almost  specific  remedy  for  that  most  distressing  malady, 
membranous  croup. 

2.  An  efficient  and  reliable  agent  in  most  bronchial  affections, 
even,  through  its  alterative  influence,  in  reflex  conditions,  voice  dis- 
turbances, etc. 

3.  In  dyspnea   (whether  due  to  affections  of  the  bronchi  and 
lungs  or  to  cardiac  disturbances)  it  proves  of  prompt  service — as  it 
does  also  in  asthma. 

4.  It  rapidly  causes  a  reduction  and  gradually  absorbs  fibroids  of 
the  uterus. 

5.  v  It  is  possibly  the  most  rapid  and  certain  remedy  for  coryza. 

6.  It  enables  the  doctor  to  administer  iodine  in  larger  quantities 
for  a  longer  time  without  causing  unpleasant  systemic  effects. 

7.  In  goiter  and  all  glandular  diseases,  Calcidin  with  nuclein 
will  prove  probably  the  most  efficient  of  all  known  remedies. 

The  conditions  calling  for  the  use  of  iodine  are  often  the  ones 
which  also  require  the  lime  salts ;  the  converse  is  also  true ;  therefore 
we  have  in  calcium  iodized  a  form  of  medication  which  gives  not 
not  only  the  most  perfect  iodine  effects,  but  does  it  without  causing 
the  slightest  sign  of  iodism  and  provides  at  the  same  time,  in  a 
most  acceptable  form,  the  lime  salt  which  is  necessary. 


CAMPHOR    MONOBROMIDE  117 

CAMPHOR    MONOBROMIDE. 

Standard  granule — Gr.  1-6,  gm.  .01.    Tablet,  gr.  j,  gm.  .06. 

Camphor  monobromide  is  obtained  by  the  direct  action  of  bro- 
mine on  camphor.  It  crystallizes  in  monoclinic  prisms,  little  soluble 
in  water,  sparingly  in  cold  and  freely  in  hot  alcohol,  easily  in  ether, 
choroform,  oils,  or  benzole.  The  odor  resembles  that  of  camphor. 

The  contradictory  reports  on  this  salt  appear  to  show  that  it  acts 
as  camphor  and  as  a  bromide,  not  as  a  new  body.  The  bromine  is 
not  excreted  by  the  kidneys  (Liebreich).  It  reduces  the  pulse,  the 
respiration  and  the  temperature  (Bourneville  and  Lawson).  It 
produces  clonic  spasm  of  the  feet,  maximal  dilatation  of  the  pupils 
during  the  spasms ;  hallucinations,  insomnia  and  emaciation  when 
its  use  is  continued  long  (Nothnagel).  Large  doses  cause  poisoning 
with  the  same  effects  as  camphor. 

Cushny  says  it  acts  as  camphor,  the  bromine  having  no  effect. 

Wood  says  it  causes  violent  convulsions,  with  muscular  weak- 
ness almost  to  the  point  of  paralysis ;  small  doses  lowering  the  tem- 
perature after  an  evanescent  rise,  with  great  diminution  in  the  rate 
of  the  respiration  and  of  the  heart,  with  occasional  periods  of  hurry 
in  each.  Stupor  ends  in  death.  The  vessels  of  the  eye  and  ear  are 
contracted.  Doses  of  45  grains  caused  tremblings,  slow  pulse,  and 
coma  lasting  six  hours. 

Hare  found  it  caused  Cheyne-Stokes  respiration,  the  pulse  at  first 
rapid  and  then  becoming  slow  and  weak.  Death  may  occur  either 
in  coma  or  in  convulsions. 

Van  Renterghem  experimented  on  himself  with  camphor  mono- 
bromide  as  follows :  The  first  day  he  took  two  granules,  gr.  1-6 
each,  every  hour  for  10  doses,  allowing  the  granules  to  dissolve  in 
the  mouth.  The  local  action  on  the  buccal  mucosa  was  limited  to  a 
sensation  of  fresh  warmth,  with  salivary  and  mucous  secretion. 
Next  day  he  took  five  granules  every  hour  for  eight  doses.  On 
neither  day  was  there  any  special  symptom  that  could  be  charged  to 
the  remedy.  The  appetite  was  good,  the  sleep  if  anything  more  than 
usually  profound.  The  third  day  he  took  fifteen  granules  hourly  for 
four  doses.  Fifteen  minutes  after  the  fourth  dose  he  felt  a  sense  of 
warmth  in  the  face ;  the  forehead,  face  and  neck  covered  with  sweat, 
the  lips  pale,  with  a  sense  of  vertigo  and  as  if  being  raised  from  the 
earth.  The  pulse  was  unaffected,  the  respirations  calm.  Dinner 
was  then  ready  but  he  could  not  swallow  a  morsel.  This  state  en- 
dured an  hour  and  subsided  slowly.  Although  able  to  attend  to 


118  CAMPHOR    MONOBROMIDE 

business  it  was  not  till  next  day,  after  a  good  night,  that  he  felt  him- 
self as  usual  and  the  gastric  derangement  had  subsided.  Under  the 
influence  of  the  massive  doses  his  temper  was  irritable. 

Burggraeve,  taking  this  agent  during  a  cold  in  the  head,  observed 
after  a  dose  of  four  granules  a  diminution  of  the  tactile  sense  of  the 
pharyngolaryngeal  mucosa.  According  to  him,  camphor  mono- 
bromide  realizes  the  ancient  saying  of  camphor :  "Camphor  dis- 
solves spasms." 

Van  Renterghem  concluded  from  his  trials  that  in  light  doses, 
of  two  to  five  granules  hourly,  this  drug  is  harmless  to  a  well  man ; 
while  in  doses  of  gr.  7^  hourly,  it  deranges  the  stomach  and  causes 
intoxication. 

Therapeutics. — Deneffe  used  it  in  delirium  tremens,  giving  3  to  4 
grams.  Hamilton  gave  it  with  benefit  in  chordee;  Gallard  in 
chorea;  Vulpian  and  Potain  in  hysteric  spasms,  palpitations,  dyspnea 
and  spermatorrhea ;  Charcot  and  Bourneville  in  epilepsy ;  Desnos  in 
prosopalgia ;  Lannelongue  in  painful  affections  of  the  bladder ; 
Rosenthal  in  nervous  palpitations  and  excessive  irritability  of  the 
bladder.  Veterinarians  have  reported  success  in  treating  sexual 
manifestations  in  the  horse,  dog,  cat  and  bull. 

Landrin  found  that  moderate  doses  prevented  irritation  of  the 
urinary  apparatus  from  the  absorption  of  cantharidin  from  blisters. 

Van  Renterghem  recommends  camphor  monobromide  in  the  dry- 
ness  of  the  tissues  in  typhus  and  cholera ;  in  all  inflammations  of  the 
respiratory,  digestive  and  genitourinary  ways;  in  all  cases  with 
tendency  to  exudation  or  the  formation  of  false  membrane ;  in  irrita- 
tions of  the  larynx  and  oesophagus ;  in  asthma  and  emphysema, 
spasmodic  and  convulsive  coughs,  whooping-cough;  certain  cardiac 
palpitations,  nervous  or  symptomatic  of  organic  lesions;  for  hy- 
peremias  in  general  and  affections  of  the  cerebral  nervous  centers  of 
congestive  form  or  due  to  stimulants ;  for  urethral  erethism,  the 
debut  of  gonorrheas  with  chordee.  It  is  the  best  sedative  of  the 
genital  system,  for  nymphomania,  hysteria,  pollutions  and  priapism. 

Berger  pronounced  it  of  value  only  in  nervous  palpitations'  and 
in  irritability  of  the  genitourinary  organs.  Rosenthal  obtained  good 
results  in  hysteric  and  nervous  headaches.  It  has  been  suggested 
for  paralysis  agitans,  and  Liebreich  found  it  effective  in  hystero- 
epilepsy. 

Wood  found  it  useful  in  hysteric  excitement,  sexual  irritation 
and  spermatorrhea,  but  of  little  value  in  delirium  tremens ;  but  Hare 
advises  it  in  the  latter  when  the  gastric  mucous  membrane  is  de- 


CAMPHOR    MONOBROMIDE  119 

pressed  and  there  are  violent  twitchings.  For' pain,  Hare  advised 
this  remedy  In  connection  with  others,  as  in  lumbago;  also  as  a 
hypnotic  in  hysteria,  for  whooping-cough,  chorea,  epilepsy  and  petit 
mal,  and  for  the  nervous  depression  and  pains  of  influenza.  Like 
camphor,  the  monobromide  warms  and  in  overdoses  irritates  the 
stomach. 

Bourneville  recommended  it  in  vertiginous  epilepsy,  but  not  in 
the  ordinary  forms. 

In  many  cases  it  seems  a  question  if  any  sedative  can  be  used, 
and  yet  there  are  irritative  symptoms'  that  need  sedation.  The  com- 
bination of  a  calmant  with  a  powerful  restorative  like  camphor  is 
admirably  suited  to  this  indication,  and  the  monobromide  of  cam- 
phor has  won  laurels  in  many  such  instances.  The  insomnia  of 
fatigue,  and  that  of  nervous  exhaustion,  are  usefully  treated  by  this 
agent  in  doses  of  seven  grains  at  bedtime,  or  a  grain  every  quarter- 
hour  till  effect.  For  such  conditions  in  children  it  is  simply  ad- 
mirable. It  does  not  usually  irritate  the  stomach  as  crude  camphor 
does :  in  fact,  the  writer's  experience  directly  contradicts  Cushny's 
statement,  for  if  either  ingredient  is  covered  up,  it  is  the  camphor. 
In  fact,  in  many  cases,  giving  this  salt  for  acute  colds,  the  desired 
camphor  effect  has  not  been  obtained. 

As  a  sexual  sedative  it  is  far  more  reliable  than  camphor,  which 
is  as  liable  to  act  as  an  aphrodisiac  as  the  contrary,  but  the  mono- 
bromide  has  never  failed  to  give  pure  and  unmixed  sedation  of  this 
function. 

Even  in  irritable  conditions  of  the  stomach  this  remedy  has  not 
caused  distress  or  nausea,  in  the  small  doses  deemed  advisable  then. 
A  granule  of  gr.  1-6  may  be  administered  every  five  minutes  for  an 
hour  or  two,  when  a  single  dose  of  five  grains  would  possibly  cause 
trouble. 

Children  with  whooping-cough  take  two  to  five  grains  at  a  dose 
without  irritation,  and  here  it  has  proved  in  our  hands  a  valuable 
sedative  for  the  cough,  though  not  shortening  the  attack  as  calcium 
sulphide  or  formalin  will  do.  The  camphor  bromide  does  not  have 
the  injurious  effect  on  the  digestive  organs,  or  the  depressing  effects 
on  the  vitality,  that  are  sure  to  follow  the  prolonged  use  of  the 
potash  bromide.  In  fact  in  children  and  delicate  females,  the  latter 
in  our  practice  has  been  entirely  superseded  by  the  camphor  bromide. 

If  the  temperature  falls  below  the  normal  the  administration  of 
camphor  monobromide  must  be  suspended.  It  is  too  irritating  to  be 


120  CANNABIS     INDICA 

used  hypodermically,  but  if  this  should  be  deemed  necessary  the 
solution  in  oil  could  be  utilized,  the  dose  being  iy2  grains. 

CANNABIS   INDICA. 

Standard  granules — Cannabin  resin,  gr.  1-67,  gm.  .001 ;  cannabin  tannate, 
er.  1-67.  gm.  .001  ;  cannabin  and  atropine  comp.  (Cannabin,  gr.  1-50;  atro- 
pine  sulphate,  gr.  i-ioo.) 

The  use  of  this  drug  as  an  intoxicant,  hypnotic  and  aphrodisiac 
in  the  East  has  invested  it  with  unusual  interest.  Under  the  names 
of  hasheesh,  bhang  and  gunjah  it  fills  with  many  races  the  places  of 
opium  and  tobacco,  and  of  alcohol.  But  though  it  has  frequently 
been  introduced  into  medical  practice  it  has  never  sustained  the 
place  for  which  it  was  urged,  or  dislodged  the  more  objectionable 
agents  for  which  it  has  been  proposed  to  substitute  it. 

No  drug  would  seem  better  calculated  to  display  the  advantages 
of  Alkalometry  than  this,  because  it  possesses  exceedingly  valuable 
properties  but  is  scarcely  used,  on  account  of  the  uncertainty  and  un- 
reliability of  its  preparations.  But  up  to  the  present  it  has  defied  all 
efforts  to  find  an  active  principle  from  which  its  remedial  virtues  can 
be  obtained. 

Merck  lists  cannabin,  a  resinoid;  cannabindon,  a  liquid,  dose  m. 
J/3  to  i ;  cannabine  alkaloid,  dose  gr.  il/2  to  4;  cannabine  tannate, 
dose  gr.  8  to  16,  maximum  daily,  gr.  40;  cannabinine;  cannabinon, 
dose  gr.  l/2  to  il/2  ',  and  an  alcoholic  extract,  dose  gr.  *4  to  2>  max- 
imum daily  gr.  5. 

Cushny  pronounces  all  the  above  merely  impure  extracts.  Hay 
reported  the  discovery  of  tetanocannabine,  with  effects  similar  to 
those  of  strychnine;  but  this  has  not  been  confirmed.  Vignolo  says 
cannabis  contains  muscarine,  and  traces  a  similarity  of  effect  with 
the  mushrooms  used  in  Russia  to  produce  pleasurable  intoxication. 

A  good  extract  like  Allen's  gives  therapeutic  effects  in  doses  of 
gr.  %  to  l/2.  It  is  obvious  that  no  derivative  requiring  doses  in  ex- 
cess of  these  can  be  looked  upon  as  the  active  principle.  The  ex- 
tracts vary  greatly,  and  every  new  sample  requires  testing  anew. 
But  the  drug  is  worth  it ;  as  we  hope  to  show. 

Physiologic  Action. — Brunton  pronounces  cannabis  hypnotic 
and  analgesic.  In  some  it  causes  visions  or  hallucinations 
previous  to  sleep,  of  pleasant  nature  or  otherwise.  It  is  not  an 
aphrodisiac,  but  gives  rise  to  erotic  dreams  or  hallucinations,  more 
frequently  in  Asiatics  than  in  Europeans.  Sometimes  it  causes  de- 
lirium, or  tendency  to  active  movements,  sensible  or  erratic,  rarely 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


CANNABIS     INDICA  121 

homicidal.  In  Europeans  the  dreams  may  be  disagreeable.  In  Asia 
it  is  the  custom  to  give  other  aphrodisiacs  with  cannabis  to  give  the 
visions  this  coloring.  The  patient  under  its  influence  may  talk  and 
act  apparently  in  a  sane  manner,  while  really  not  so.  In  some  case? 
there  is  a  curious  loss  of  the  sense  of  time  and  space,  so  that  ages 
apparently  elapse  in  a  moment.  In  others  the  phenomenon  of  double 
consciousness  is  presented,  the  two  sides  of  the  brain  appearing  to 
act  independently.  Given  short  of  hypnosis  a  dreamy  state  super- 
venes, the  judgment  being  in  abeyance,  the  imagination  free.  The 
visions  and  speech  may  show  boundless  extravagance,  but  vary  with 
the  individual.  The  movements  may  be  absurd,  the  ideas  incoherent : 
there  may  be  a  sense  of  impending  danger  or  death,  or  the  condition 
is  of  euphoria,  comfort,  well-being,  self-satisfaction.  Consciousness 
is  not  all  lost  but  restraint  is  weakened  or  lost.  When  aroused  or 
questioned  the  answers  may  be  rational.  The  sense  of  pain  is  weak- 
ened or  lost,  that  of  touch  lost.  In  some  this  pleasant  stage  is  absent 
and  there  is  merely  a  heavy,  drowsy  feeling,  with  tinnitus,  and 
numbness.  Some  experience  a  sense  of  fullness  in  the  chest,  as  if 
it  were  bursting.  Heaviness  of  the  arms  and  legs  may  be  felt,  the 
head  hot  and  heavy,  the  eyes  bright  and  shining,  dizziness,  noises  in 
the  ears  and  pleasant  anesthesia.  Pressure  excites  a  sense  of  burn- 
ing. Rarely  it  causes  maniacal  attacks  or  convulsions.  Periods  of 
unconsciousness  alternate  with  the  foregoing,  and  finally  deep  and 
healthful  sleep  supervenes.  Some  say  sleep  is  secured  in  only  fifty 
per  cent  of  cases,  but  this  is  too  little,  in  our  experience. 

From  this  sleep  the  patient  awakes  refreshed,  with  no  headache 
or  disturbance  of  the  digestion — no  nausea  or  constipation. 

Cannabis  affects  the  nervous  centers  like  morphine,  with  a  mix- 
ture of  sedation  and  stimulation.  The  respiration  may  be  accelerated 
or  slowed,  the  action  on  the  pulse  also  being  irregular,  first  faster, 
then  slower.  The  temperature  may  be  raised  or  lowered  as  motion 
is  or  is*  not  induced,  falling  as  sleep  comes  on.  The  sensory  nerves 
are  benumbed,  the  pupils  dilate.  The  legs  especially  become  anes- 
thetic. Large  doses,  however,  slow  the  respiration  quite  uniformly. 
Death  from  cannabis  is  very  rare;  Hare  says  none  has  ever  been 
reported. 

The  nutrition  is  not  affected  by  the  habitual  use  of  this  drug. 
Shoemaker  says  it  causes  mental  deterioration  and  unfitness  for 
work.  In  the  East  the  use  is  said  to  lead  to  dementia  or  mania. 

Locally  cannabis  is  an  irritant  to  muscular  tissue,  anesthesia  fol- 


122  CANNABIS     INDICA 

lowing ;  but  the  irritation  is  too  great  to  allow  its  use  as  a  local  anes- 
thetic. 

Cannabis  increases  the  excretion  of  urine. 

Therapeutics. — Cannabis  covers  a  large  field.  Brunton  rec- 
ommended it  as  a  hypnotic  in  acute  and  chronic  mania ;  as  an 
analgesic  in  neuralgia,  migraine,  etc. ;  to  relieve  spasmodic  coughs, 
and  for  menorrhagia.  For  constant  headaches,  from  cerebral  tumors 
and  other  causes,  this  author  recommends  it.  It  relieves  the  tremors 
of  senility  and  of  paralysis  agitans ;  the  lightning  pains  of  locomotor 
ataxia;  gastralgia  and  enteralgia — in  fact  Germain  See  pronounced 
it  a  specific  for  pains  below  the  diaphragm.  Even  the  agonies  of 
renal  and  hepatic  calculi  are  eased  by  cannabis,  as  well  as  those  of 
rheumatism,  gout  and  cancer.  It  relieves  the  delirium  of  softening 
of  the  brain,  and  a  dose  at  bedtime  puts  a  stop  to  unpleasant  dreams. 
Taken  internally  it  stops  the  itching  of  eczema  as  well  as  senile  and 
many  other  forms  of  pruritus ;  but  a  caution  as  to  the  formation  of 
a  cannabis  habit  is  here  necessary. 

Pains  in  the  uterus  are  relieved  by  cannabis,  while  its  contrac- 
tions are  increased  and  steadied ;  in  which  we  may  find  a  reason  for 
the  use  of  this  agent  in  uterine  hemorrhages',  both  menorrhagia  and 
metrorrhagia.  It  relieves  the  headaches  and  checks  the  hemorrhages 
of  the  menopause,  and  in  fact  is  vaunted  as  a  general  hemostatic. 

Does  it  cure  diabetes?  Probably  not,  but  at  least  it  relieves  the 
attendant  cerebral  irritation  and  the  itching. 

It  has  been  praised  as  a  remedy  for  asthma,  whooping-cough 
and  hay  fever;  for  tickling  in  the  throat,  and  for  the  cough  of 
advanced  phthisis,  where  it  enables  us  to  long  postpone  the  resort  to 
morphine. 

See  particularly  recommended  cannabis  as  a  sedative  in  gastric 
cases  with  pain,  acidity  and  flatulence ;  also  in  gastric  ulcer.  In  pain 
from  nerve  disturbance  Hare  advises  it ;  as  in  migraine,  giving  first 
a  full  dose  of  gelsemium  and  then  cannabis ;  also  in  true  migraine 
with  hemianopsia  which  it  aborts-  very  effectively.  He  suggests  it 
in  paralysis  agitans,  spasm  of  the  bladder,  and  in  inorganic  im- 
potence, in  headache  from  retinal  asthenopia,  in  subinvolution  and 
chronic  metritis,  in  nervous  and  spasmodic  dysentery,  and  for 
chordee.  In  acute  and  chronic  nephritis  it  relieves  the  hematuria 
and  the  pain. 

Murrell  testifies  to  its  benefits  in  sick  headaches. 

Cannabis  has  been  used  with  asserted  success  for  exophthalmic 
goiter. 


CANTHARIDIN  123 

Shoemaker  advises  it  as  a  hypnotic  for  acute  dementia  from 
anxiety,  and  for  melancholy;  also  in  delirium  tremens.  He  men- 
tions its  use  in  tetanus  and  in  epilepsy. 

Cannabis  has  been  used  in  the  treatment  of  opium  and  other 
habits,  with  some  success.  If  the  narcomania  cannot  be  entirely 
cured,  it  is  unquestionably  better  that  the  patient  should  substitute 
the  cannabis  habit  for  any  opiate ;  but  in  all  the  cases  in  which  the 
writer  tried  to  do  this  he  failed.  The  patients  quite  willingly  added 
this  to  their  other  accomplishments,  but  there  they  quit. 

In  the  latter  stages  of  incurable  phthisis,  cancer  and  other  pain- 
ful affections,  the  greatest  relief  ensues  from  the  formation  of  the 
cannabis  habit.  In  painful  affections  of  the  heart,  such  as  angina 
pectoris,  the  pain-relieving  and  muscle-steadying  effects  noted  in 
uterine  maladies  might  be  duplicated. 

The  full  adult  dose  of  a  good  extract  is  gr.  %.  This  may  be  re- 
peated every  hour  till  effect.  With  children  the  dose  should  follow 
the  opiate  rule,  being  relatively  smaller  than  for  adults.  A  granule 
of  gr.  1-6  for  adults  and  gr.  1-67  for  children  would  meet  the  needs. 

If  the  use  of  cannabis  is  followed  by  delirium  it  should  be  com- 
bined with  veratrine,  or  with  cicutine  if  movement  is  prominent. 
The  hypnotic  effect  may  be  developed  by  adding  a  moderate  dose 
of  hyoscine,  or  of  camphor  monobromide.  For  its  anodyne  effects 
the  addition  of  menthol  for  the  stomach,  hyoscyamine  for  neuralgia, 
acetanilid  for  headache,  should  prove  effective.  In  fact,  this  is  an 
admirable  ingredient  in  the  hands  of  the  man  who  knows  how  to 
mix  drugs  to  get  their  combined  effects. 

CANTHARIDIN. 

Standard  granule — Gr.  1-5000,  gm.  .00012. 

Cantharidin,  C]0  H12  O4,  constitutes  from  0.3  to  0.5  per  cent  of 
cantharides,  from  which  it  is  extracted  by  chloroform.  Cantharidin 
is  the  anhydride  of  cantharidic  acid,  and  crystallizes  in  rectangular, 
colorless  plates,  slightly  soluble  in  water  or  in  cold  alcohol,  readily 
soluble  in  hot  alcohol,  in  ether,  chloroform  or  fatty  oils.  By  taking 
up  water  cantharidic  acid  is  formed,  which  unites  with  alkalies  to 
form  water-soluble  salts.  Cantharidin  is  by  preference  excreted  by 
the  kidneys. 

Physiologic  and  Toxic  Actions. — Liebreich  attributes  to  canthari- 
din  the  essential  effects  of  cantharides.  He  attributes  the  special 
effect  of  cantharidal  vesication  to  the  cantharidin  absorbed.  The 


124  CANTHARIDIN 

salts  in  solid  form  are  liable  to  decomposition,  but  potassium  or 
sodium  cantharidate  can  be  administered  by  the  stomach  or  hypo- 
dermically,  in  weak  alkaline  water  solution. 

Animals  can  be  fed  with  hypo-toxic  doses  for  months  without 
perceptible  ill-effects.  If  the  dose  be  increased  but  still  kept  below 
the  toxic  limit,  the  kidneys  become  soft,  not  hyperemic,  serum- 
soaked,  showing  that  the  capillaries  allow  transudation  of  serum  to 
an  abnormal  degree.  Cantharidin  has  then  a  special  action  on  the 
capillaries. 

Are  these  merely  passive  channels  for  fluid-  transmission,  or 
have  they  a  special  function  like  other  body-cells?  Heidenhain 
showed  that  the  capillaries1  can  be  specially  influenced  by  chemical 
substances.  At  any  rate,  cantharidin  coming  in  contact  with  the 
capillaries  causes  them  to  exude  more  serum.  It  may  be  inferred 
that  the  capillaries  of  each  different  organ  functionate  in  their  own 
special  manner.  As  cantharidin  in  larger  than  the  usual  doses 
causes  an  excessive  transudation,  it  may  be  assumed  that  in  smaller 
doses  it  has  a  similar  though  imperceptible  effect.  If  any  organ  is 
so  diseased  that  the  serum-secretion  of  its  capillaries  is  impaired, 
cantharidin  may  tend  to  restore  normal  secretion,  even  in  doses  as 
yet  too  small  to  affect  the  kidneys.  This  increase  of  serum-excretion 
necessitates  a  large  supply  of  nutriment  to  the  affected  cells,  so  that 
the  latter  are  strengthened.  Hence,  cantharidin  is  useful  when  dis- 
ease is  due  to  external  action,  or  to  affections  of  the  tissues'.  This 
explains  the  general  tonic  action  previously  observed  as  following 
the  use  of  cantharidal  blisters.  This  is  especially  the  case  when 
microorganisms  attack  the  tissues,  weakened  by  previous1  disease  or 
traumatism.  Pulmonary  tuberculosis  is  especially  a  fit  example. 
Petteruti  reports  three  cures  by  cantharidin. 

When  toxic  but  not  lethal  doses  are  taken  they  cause  gastric 
burning  and  pain,  great  thirst,  the  salivary  glands  swell  and  dis- 
charge freely,  the  pulse  slows,  diuresis  and  diaphoresis  appear,  with 
strangury,  tenesmus  and  diarrhea.  The  symptoms  disappear  in 
twenty-four  hours,  leaving  no  ill  trace.  In  severer  poisoning- 
nausea  and  vomiting  occur.  The  appetite  may  become  ravenous,  the 
pulse  irregular,  filiform  and  rapid.  Urine  is  increased,  with  pain 
and  strangury  between  micturitions,  increasing  as  the  urine  becomes 
bloody,  with  leucocytes  and  fibrinous*  coagula  moulded  on  the  bladder 
wall.  Consciousness  is  unaffected,  but  there  are  trembling  and  per- 
haps convulsions.  Even  here  recovery  may  follow  rapidly. 

In  fatal  poisoning  there  are  acute  gastritis  and  enteritis,  spasm 


CANTHARIDIN  125 

of  the  oesophagus,  dysphagia ;  drinking  is  impossible  as  in  rabies  and 
atropine  poisoning  (Nothnagel)  ;  there  is  vomiting  and  violent  diar- 
rhea, bloody  dysentery,  the  urine  suppressed.  Cantharides  does  not 
excite  sexual  activity,  the  severe  priapism,  turgidity  and  even  gan- 
grene of  the  penis,  being  in  no  sense  pleasurable.  In  pregnant 
women  it  may  cause  abortion,  without  exciting  sexual  desire.  Some 
authors  fail  to  comprehend  that  irritation  of  the  sexual  organs  is  not 
the  same  as  stimulation  of  the  sexual  sensation.  A  blister  on  the 
glans  would  not  accomplish  the  latter  object.  These  symptoms  are 
most  frequently  the  result  of  cantharidal  blisters.  Large  doses  of 
cantharidin  taken  internally  cause  burning  in  the  urethra  and 
albuminuria.  The  latter  often  follows  fly-blistering  (Gubler),  ceas- 
ing when  the  application  is  removed. 

Small  animals  given  cantharidin  o.oi  (gr.  1-6),  presented 
glomerulo-nephritis,  the  cells  of  the  tubuli  uriniferi  congested,  with 
hemorrhages  in  the  renal  and  tubular  tis&ues. 

Nothnagel  says  pure  cantharidin  acts  on  the  skin  in  doses  of 
0.00002  in  twenty  minutes  or  less,  the  action  occurring  more 
promptly  when  oil  is  used  as  a  solvent.  If  a  spot  on  a  rabbit's  skin 
is  painted  with  cantharidal  collodion  daily  for  two  weeks  the  usual 
phenomena  of  blistering  ensue,  then  the  underlying  vessels  dilate, 
but  the  fat  disappears ;  the  deeper  tissues,  muscles,  pleura  and  lung 
become  anemic  (Zuelzer). 

Nothnagel  attributes  the  affection  of  the  genito-urinary  tract  to 
the  local  action  of  the  cantharidin  excreted  by  the  kidneys. 

Schachowa  noted  the  presence  of  numerous  bacteria  in  the  urine 
when  toxic  doses  were  given,  and  these  persisted  until  death.  The 
reaction  was  alkaline.  Fat  appeared  on  the  eighteenth  day  of  the 
continuous  administration.  Albuminuria  occurred  only  on  the  third 
day  and  not  afterwards.  He  found  the  alteration  limited  to  the 
epithelium  of  the  tubuli  uriniferi,  which  was  discharged  as  epithelial 
and  fatty  casts.  The  glomeruli,  capillary  network,  connective 
stroma  and  membrana  propria  were  unaffected,  save  for  slight  thick- 
ening of  the  latter  from  maceration  with  serum.  Small  doses  are 
excreted  by  the  spiral  renal  tubules;  larger  by  the  part  nearer  the 
glomeruli  and  by  the  convuluted  tubules,  the  part  nearest  the 
glomeruli  functionating  last.  Only  when  the  largest  doses  are  given 
are  changes  observed  in  the  rest  of  the  uriniferous  tubules,  and  least 
in  the  collecting  tubes  (Langhaus-Schachowa). 

Radecki  found  large  doses  cause  headache,  formication,  later  on 


126  CANTHARIDIN 

stupefaction,  dyspnea,  central  respiratory  paralysis,  and  death  after 
general  spasms,  by  carbonic  acid  poisoning. 

Dragendorff  recovered  cantharidin  from  the  putrid  body  of  a 
cat  eight  days  after 'death.  Muscular  tissue  from  chickens  fed  on 
cantharidin  killed  a  cat  with  the  characteristic  symptoms. 

Brunton  states  that  cantharides  affects  the  trachea  and  larger 
bronchi,  causing  congestion  and  irritation.  It  appears,  therefore 
that  cantharidin  is  eliminated  by  all  the  mucous  membranes,  as 
vesication  in  the  alimentary  tract  has  been  found  even  when  the  drug 
is  administered  hypodermically  (Cushny). 

Therapeutics. — In  doses  of  one  minim  of  the  tincture,  cantharides 
checks  hematuria;  in  large  doses  it  increases  the  disease  (Brunton). 

In  acute  nephritis,  when  the  acute  symptoms  pass  and  a  little 
albumin  and  blood  are  still  to  be  found  in  the  urine,  it  is  very  useful 
in  doses  of  one  to  three  minims,  every  three  hours  (Brunton). 

In  lupus,  cantharidin  was  injected  hypodermically  by  Liebreich, 
curing  incipient  and  lighter  cases  completely.  In  other  cases  where 
nutritive  disturbances  were  marked,  this  agent  acted  beneficially. 
Its  use  must  be  methodical.  It  is  contraindicated  in  renal  disturb- 
ances, but  if  the  kidneys  are  sound  the  drug  may  be  given  for  years 
without  disturbing  them  or  causing  any  other  observable  ill-effect. 
The  dose  accurately  fixed  in  any  given  case,  may  be  administered 
for  years  without  alteration,  though  the  least  increase  is  ill  borne, 
producing  dysuria  and  diarrhea. 

In  cystitis  when  there  is  inability  to  retain  the  urine,  and  in 
ordinary  incontinence  of  urine,  it  is  useful,  though  atropine  is  gen- 
erally better  (Brunton). 

Chordee  is  often  relieved  by  a  drop  of  the  tincture  three  times 
a  day  (Brunton). 

Cantharides,  one  part  of  the  tincture  to  eight,  is  a  useful  lotion 
for  promoting  the  growth  of  the  hair  (Murrell). 

Large  doses  are  useful  in  impotence  of  elderly  men  (20  minims 
thrice  daily,  after  meals),  but  accessory  treatment  is  desirable 
(Murrell).  This  is  a  very  dangerous  dose. 

Small  doses  cure  the  slight  incontinence  of  urine  in  women,  with 
cough  ( Murrell). 

In  doses  not  exceeding  0.12  to  0.18  c.  c.  (m.  2  to  3)  the  tincture 
has  been  commended  in  pyelitis,  cystitis,  gleet  and  leucorrhea.  It  is 
contraindicated  in  acute  inflammation ;  it  has  succeeded  in  atonic 
amenorrhea,  and  has  suppressed  passive  atonic  seminal  emissions ; 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


CANTHARIDIN  127 

there  is  some  evidence  to  show  that  the  internal  administration  may 
check  the  progress  of  cancer  (Shoemaker). 

Full  doses  are  useful  in  impotence  from  old  age,  sexual  excess 
or  masturbation  (Ringer). 

In  simple  and  tubercular  laryngitis  potassium  cantharidate 
causes  serous  exudation,  which  is  speedily  reabsorbed.  Hoarseness 
diminishes  and  swallowing  is  easier  (Liebreich). 

Hennig  applied  cocaine  cantharidate  locally  in  tuberculosis, 
ozena,  and  mucous  syphilis;  three  to  six  parts  in  2,000  of  chloro- 
form water. 

Cantharis  has  been  given  internally  as  a  systemic  stimulant  after 
debilitating  fevers  (Shoemaker). 

In  late  stages  of  nephritis,  with  relaxed,  torpid  kidneys,  or  where 
albuminuria  comes  after  slight  exertion,  tincture  of  cantharides  0.05 
(m.  i)  thrice  a  day,  is  of  great  service;  also  in  chronic  alcoholic 
nephritis,  irritability  of  the  bladder  in  women  and  children  with  de- 
pression, very  chronic  gleet  and  prostatorrhea ;  internally  in 
psoriasis,  eczema,  lichen  and  prurigo  (Hare). 

Its  administration  in  cholera  and  epilepsy  has  fallen  into  com- 
plete disuse. 

Diabetes  insipidus  has  been  arrested  by  the  internal  use  of 
cantharides;  it. is  also  useful  for  menorrhagia  in  weak  women 
(Butler). 

It  is  of  some  benefit  in  dropsies,  especially  following  scarlatina ; 
in  the  later  stages  of  diabetes,  and  in  acne  with  uterine  irritation 
(Ellingwood). 

A  careful  study  of  the  literature  of  cantharides  shows  that  the 
active  principle  is  largely  excreted  by  the  kidneys,  to  a  less  extent 
by  the  gastro-intestinal  mucosa  and  slightly  if  at  all  by  the  respira- 
tory mucosa.  I  have  been  unable  to  find  any  conclusive  or  even 
probable  evidence  to  show  any  action  whatever  apart  from  the  local 
effects  produced  on  the  mucous  surfaces  and  other  tissues  by  which 
the  drug  is  excreted.  The  therapeutic  effects  are  therefore  to  be 
exclusively  attributed  to  this  local  action.  Even  the  succulence  of 
the  tissues  described  by  Liebreich  conies  under  this  head,  and  he 
describes  none  of  this  beyond  the  excretory  membrane.  In  states  of 
relaxation  and  debility  of  the  genitourinary  organs  we  may  expect 
from  cantharidin  the  same  stimulant  effect  exerted  on  a  cutaneous 
ulcer  by  a  weak  solution  of  silver.  This  applies  also  to  the  uterus, 
and  the  endometrium  probably  excretes  and  is  stimulated  by  can- 
tharidin. To  a  less  extent  the  lower  bowel  is*  similarly  affected  by 


128  CANTHARIDIN 

this  agent,  and  in  relaxation  of  the  rectal  tissues,  prolapse  and  pas- 
sive hemorrhoids,  chronic  catarrh  and  ulcer  of  the  rectum,  canthari- 
din.  would  be  a  useful  stimulant  if  the  dose  required  does  not  prove 
too  irritant  to  the  urinary  mucosa.  Consequently  I  very  strongly 
doubt  if  doses  large  enough  to  favorably  affect  the  respiratory 
mucosa  can  be  given  without  harm  to  the  kidneys,  since  very  little 
of  the  drug  is  excreted  by  the  lungs.  Beyond  these  organs  I  am 
unable  to  find  any  reason  for  the  administration  of  cantharidin. 

In  regard  to  its  effect  as  an  aphrodisiac  the  evidence  is  conflict- 
ing. Most  authors  deny  that  there  is  any  excitation  of  the  sexual 
appetite,  the  priapism  being  only  caused  by  toxic  doses,  and  as  a 
symptom  of  serious  poisoning.  I  have  given  the  drug  many  times 
in  moderate  doses  without  eliciting  the  slightest  pleasant  sexual 
sensation ;  and  in  the  only  cases  where  erections  were  produced  the 
suffering  was  too  great  to  admit  of  any  thought  of  pleasure.  When 
impotence  is  attended  with  relaxation  of  the  genitourinary  tissues, 
moderate  doses  of  cantharidin  may  be  useful  in  imparting  tonicity, 
and  the  drug  may  be  of  some  value  as  an  adjuvant  to  strychnine,  but 
nothing  more ;  and  of  the  two  strychnine  is  preferable,  since  there 
will  be  also  then  present  atony  of  the  whole  body,  including  tissues 
not  influenced  by  cantharidin.  And  it  would  not  be  politic  in  such 
cases  to  restore  the  strength  of  this  function  while,  the  more  vital 
processes  are  left  in  a  state  of  debility. 

Cantharidin  must  be  looked  upon  as  a  highly  specialized  weapon, 
delicate  and  keen-edged,  capable  of  doing  much  good  in  a  limited 
group  of  affections,  but  dangerous  in  unskilled  hands.  It  is  strictly 
a  drug  for  dosimetric  administration,  and  should  never  be  given  in 
rare  large  doses,  but  in  minimal  quantities  rapidly  repeated,  until 
the  beginning  of  burning  in  stomach  or  urethra  shows  the  physi- 
ologic limit  to  be  reached.  And  as>  many  of  the  beneficial  effects  of 
fly-blisters  are  due  to  the  cantharidin  absorbed,  the  internal  ad- 
ministration may  well  replace  the  blister  in  many  instances. 

We  here  meet  the  same  cogent  query  as  in  the  case  of  arsenic. 
Having  determined  that  cantharidin  exerts  its  power  upon  certain 
selective  cells,  in  the  physiologic  state,  as  above  shown,  is  this  power 
exerted  curatively  upon  these  cells  when  diseased?  Were  our 
knowledge  complete  of  the  intimate  nature  of  disease-processes,  as 
affecting  each  tissue,  each  variety  or  group  of  cells,  this  question 
might  be  answered  a  priori.  As  it  is,  the  only  way  to  determine  the 
truth  is  by  actual  trial.  There  is  here  room  for  very  extended  ex- 
perimentation, to  confirm  or  disprove  the  clinical  observations  of 


CAPSICIN  129 

earlier  days,  when  medicinal  agents  of  uncertain  and  shifting 
strength  and  composition  were  employed,  and  the  difference  be- 
tween post  hoc  and  propter  hoc  was  little  regarded. 

Especially  I  would  recall  attention  to  the  claim  recorded  by 
Shoemaker,  of  the  arrest  of  the  growth  of  cancer  by  cantharidin. 
This  is  too  important  to  be  permitted  to  go  without  investigation. 
As  in  lupus,  when  the  cancer  is  within  reach  it  would  be  best,  per- 
haps, to  inject  the  solution  hypodermically  into  the  neoplastic 
growth.  For  this  the  combination  known  as  cocaine  cantharidate  is 
suggested.  This  is  said  to  be  a  mechanical  mixture  like  caffeine 
citrated,  not  a  chemical  union ;  but  the  resultant  mass  is  freely  solu- 
ble in  water,  which  cantharidin  is  not. 

As  to  the  value  of  potassium  cantharidate  in  tuberculosis, 
Nothnagel  condemns  it;  but  condemnation  is  habitual  with  this 
writer,  who  rarely  finds  good  in  any  remedy.  Petteruti's  three  cases 
were  abandoned  by  him  as  failures,  but  on  examining  them  some 
time  later  he  was  surprised  to  find  them  cured.  A  true  pessimist 
would  not  have  made  the  final  examination  but  suffered  the  cases  to 
go  on  record  as  failures. 

Liebreich  gives  the  dose  of  cantharidin  as  0.0002  to  0.0008  (gr. 
1-667  to  1-167),  we^  diluted.  Sodium  cantharidate  is  injected  into 
patches  -of  lupus.  Dose  o.oooi  for  adults,  every  other  day, 
suspended  if  diarrhea  or  dysuria  occurs. 

Dietrich's  cantharidin  oil  is  composed  of  one  part  cantharidin. 
960  parts  of  olive  oil  and  40  of  acetone. 

Schroff  fixed  the  lethal  dose  of  cantharides  for  man  at  2.0  (gr. 
30),  but  of  course  the  toxicity  of  various  specimens  varies  greatly. 

For  use  by  the  dosimetric  method  the  adult  dose  may  be  placed 
at  o.ooooi  (gr.  1-6000)  repeated  every  hour  until  slight  burning  is 
felt  in  the  stomach  or  urethra. 


CAPSICIN. 

Standard  granule— Gr.  1-134,  gm.  .0005. 

Some  day  we  will  realize  the  importance  of  that  great  aggrega- 
tion of  nerve  ganglia  to  which  Byron  Robinson  gave  the  name  of 
the  Abdominal  Brain ;  and  when  we  do  the  value  of  capsicum  will  be 
also  appreciated.  The  Eclectics  have  done  so,  and  the  rich  thera- 
peutics ascribed  to  this  remedy  by  them  contrasts  notably  with  the 
poverty  of  the  same  as  found  in  our  own  works. 


130  CAPSICIN 

Capsicum  contains  a  crystalline  principle  on  which  its  activity 
depends,  but  probably  the  most  efficient  concentration  to  be  found 
in  the  markets  is  the  oleoresin,  which  is  active  enough  for  all  prac- 
tical purposes. 

In  all  tropical  countries  capsicum  is  used  as*  a  condiment,  or 
rather  as  a  dietary  article  of  daily  consumption,  in  quantities  that 
would  appear  fabulous  to  the  resident  of  colder  lands.  That  there  is 
a  reason  behind  this  no  one  will  deny ;  but  whether  it  is  because  the 
climate  renders  advisable  an  equalization  of  the  inner  and  outer  heat, 
or  the  digestion  fails  without  such  powerful  stimulus,  or  that  it 
acts  as  a  check  on  the  growth  of  .gastric  flora  and  fauna,  is  a  matter 
of  conjecture.  Certain  it  is  that  the  Caucasian  removing  to  the 
tropics  soon  falls  into  the  ways  of  the  country  and  takes  his  chile 
con  came,  hot  tamales,  curry,  and  other  hot  concoctions  like  the 
native. 

But  whether  this  practice  does  or  does  not  conduce  to  longevity 
in  the  native  or  habitant  of  the  tropics,  it  is  certain  that  here  it  is 
calculated  to  wear  out  the  digestive  functions  and  shorten  the  work- 
ing life  of  the  stomach  and  liver.  The  writer  recollects  a  well- 
known  citizen  of  an  eastern  city,  who  was  accustomed  to  call  at  the 
restaurant  for  a  steak,  which  he  would  punch  full  of  holes  with  an 
instrument  he  carried  for  that  purpose,  and  fill  the  holes  with 
capsicum  till  the  quantity  almost  equaled  that  of  the  meat,  and  then 
eat  it. 

If  the  digestion  requires  the  stimulus  of  capsicum,  it  requires 
still  more  the  attention  of  a  physician  who  understands  the  digestive 
system,  if  such  an  one  may  be  found,  and  a  really  scientific  regulation 
of  diet,  exercise,  and  the  personal  hygiene  in  general.  But  it  seems 
preferable  for  the  multi-millionaire  to  resort  to  tabasco.  Well,  if 
this  shortens  his  life,  we  see  in  this  another  exemplification  of  that 
law  of  compensation  of  which  the  world  shows  so  many  cases*. 

Fifteen  years  ago  three  men,  physicians,  were  rivals  in  their 
spheres,  as  professors  of  the  same  branch  in  three  medical  colleges 
in  one  city.  One  recognized  when  he  had  enough,  and  drew  out. 
leaving  the  field  to  his  victorious'  rivals.  They  are  dead ;  have  been 
for  years,  while  he  still  lives  and  enjoys  health  and  we  trust  use- 
fulness. 

Which  was  victorious? 

The  most  important  function  of  capsicum,  and  the  least  appre- 
ciated, is  as  a  stimulant  to  the  solar  plexus,  rousing  the  vitality  and 
awaking  the  vital  resistance  to  the  onslaught  of  disease.  In  the 


CAPSUMX  i:n 

collapse  of  choleras,  the  chill  of  malarias  or  other  sudden  and 
powerful  infections,  in  the  algid  stage  of  tropic  dysentery,  the  in- 
fluence of  a  decided  dose  of  capsicum  thrown  into  the  stomach  is 
something  to  be  appreciated  when  once  seen. 

What  is  the  physiologic  effect?  In  small  doses  it  is  followed 
by  a  sense  of  warmth  in  the  stomach,  the  secretion  of  gastric  juice 
is  stimulated,  and  all  the  digestive  functions  aroused.  Of  course 
the  repetition  of  this  in  time  wears  out  the  susceptibility  of  these 
organs,  they  cease  to  secrete  without  the  capsicum,  and  gradually 
it  loses  its  effect,  so  that  the  digestion  is  worn  out. 

In  very  large  or  toxic  doses  capsicum  causes  vomiting,  giddiness, 
purging,  pain  in  the  stomach  and  bowels,  acute  gastritis,  and  in- 
toxication, with  feebleness  of  the  nervous  powers. 

The  dose  necessary  to  produce  such  effects  depends  largely  on 
the  patient's  habits.     If  his  stomach  has  been    seared    by    long  in- 
dulgence in  stimulants  or  condiments,  it  requires  very  large  doses ;  . 
if  unaccustomed  to  them,  we  should  be  cautious  in  administering 
the  doses  hereinafter  recommended. 

Therapeutics. — The  list  of  affections  for  which  capsicum  has 
been  recommended  is  long. 

Colds :  Capsicum  in  hot  infusion  is  one  of  the  domestic  rem  • 
edies  to  break  up  a  cold.  It  ranks  with  the  hot  toddies,  etc.,  and  is 
open  to  the  same  objections  that  they  increase  the  vascular  pressure 
and  thus  add  to  the  hyperemia  of  the  affected  tissues.  The  use  of 
the  depleting  method,  abstracting  fluid  by  glycerin  from  the  swollen 
tissues  directly,  or  from  the  blood  by  eliminants,  will  soon  prove 
itself  the  better  way.  But  when  one  has  been  exposed  to  cold 
while  riding,  and  comes  into  the  house  chilled,  a  bowl  of  red  pepper 
tea  will  arouse  the  vital  resistance  and  send  the  blood  equally 
through  the  vessels  and  prevent  a  threatened  congestion,  as  well  as 
any  other  stimulant,  and  better  than  an  alcoholic  beverage. 

In  catarrhs  of  the  pharynx  the  use  of  capsicum  as  a  gargle  is  of 
value  in  arousing  the  diseased  and  weakened  tissues  to  a  healthier 
grade  of  action.  The  same  remedy  has  proved  effective  in  relieving 
hoarseness. 

In  atonic  dyspepsia  and  chronic  gastric  catarrh,  capsicum  in 
small  doses  is  a  valuable  stimulant,  and  aids  the  digestion  while 
other  measures  are  restoring  the  strength. 

In  delirium  tremens  capsicum,  in  doses  of  twenty  grains  to  sixty, 
will  do  more  to  secure  sleep  and  restore  the  nervous  system  to  its 
balance  than  any  of  the  direct  hypnotics,  singly  or  combined.  In  fact, 


132  CAPSICIN 

the  use  of  capsicum  was  the  writer's  main  reliance  until  the  true 
treatment  of  this  malady  by  elimination  was  comprehended.  When 
a  man  is  crazy  for  drink,  insisting  on  repeated  drams  till  drunk, 
hardly  waiting  till  one  is  down  till  calling  for  another,  give  a  •tea- 
spoonful  of  capsicum  in  an  ounce  of  whisky.  It  will  divert  the  mind 
into  a  different  channel — mainly  that  of  swallowing  ice — and  in- 
stantly stop  the  calls  for  alcohol.  From,  this  huge  dose  we  have 
never  known  harm,  but  of  course  it  has  only  been  called  for  in 
inebriates,  whose  stomachs  were  well  prepared.  But  the  adminis- 
tration of  a  grain  of  emetine  is  better,  if  the  patient  can  be  kept  quiet 
till  it  puts  him  to  sleep. 

In  the  algid  forms  of  malaria,  congestive  chills,  a  full  dose  of 
capsicum  will  do  more  than  any  other  remedy  to  arouse  reaction. 
It  vill  require  but  half  the  dose  of  quinine,  or  less,  to  do  the  work 
when  capsicum  is  added. 

The  atonic  dyspepsia  of  drunkards  is  usefully  treated  by 
capsicum,  taken  freely  as  a  condiment.  Here  the  effect  is  partly  due 
to  the  stimulation  of  digestive  secretion,  partly  to  relief  of  the 
tormenting  thirst,  and  partly  to  a  direct  action  of  the  drug  in  stim- 
ulating the  nervous  system.  There  is  also  "an  effect  on  the  liver  that 
is  of  value. 

In  chronic  congestion  of  the  kidneys  capsicum  is  said  to  dimin- 
ish the  irritation  and  increase  capillary  activity;  but  here  the  writer 
has  had  no  experience.  When  the  kidneys  require  stimulation  of  the 
dialyzing  membrane  it  unfortunately  happens  that  they  will  not 
bear  it.  Very  small  doses  of  any  volatile  oil,  like  juniper,  will  in- 
crease the  excretion,  but  if  the  dose  is  increased  the  excretion  at 
once  falls  off  in  a  disquieting  manner. 

In  passive  diarrheas,  and  when  a  general  stimulant  is  indicated, 
capsicum  carefully  given  is  very  beneficial. 

Torpid,  sluggish  forms  of  piles  are  helped  by  capsicum,  which 
arouses  a  healthier  circulation. 

In  all  the  formulas  for  chronic  or  habitual  constipation  capsicum 
forms  a  useful  ingredient,  aiding  to  arouse  a  healthier  state  of  feel- 
ing in  the  intestinal  mucosa,  and  rendering  other  remedies  more 
effectual. 

In  dysenteries  with  vesical  tenesmus,  laxity  and  weak  digestion, 
capsicum  has  been  found  beneficial.  It  is  of  course  not  suited  for 
the  acute  stages,  where  the  indication  is  to  sedate  abnormal  irrita- 
bility; but  when  the  tissues  threaten  to  fall  into  sphacelus  from  the 


THERAPEUTIC    NOTES 


CAPSICIN  133 

intensity  of  the  infection,  or  when  the  malady,  continues  from  de- 
ficient vitality,  capsicum  is  the  most  potent  remedy. 

The  same  may  be  said  as  to  its  use  in  low  fevers.  If  the  vitality 
were  sufficient  the  tissues  would  throw  off  the  disease  and  take  on 
reparative  action ;  and  then  capsicum  may  succeed  in  arousing  the 
remaining  forces.  It  is  obvious  that  the  condition  should  be  thor- 
oughly comprehended  before  such  a  remedy  is  administered.  The 
man  who  assumes  that  capsicum  is  "good  for  dysentery"  had  better 
let  it  alone. 

In  organic  paralyses  with  digestive  torpor  the  use  of  capsicum 
improves  the  digestion,  and  this  reacts  on  the  paretic  affection  in  a 
way  that  has  given  the  treatment  repute,  with  those  who  do  not  ap- 
preciate the  value  of  a  good  food  supply,  well  digested,  and  the 
prevention  of  autotoxemia,  in  such  cases. 

The  solar  plexus  stimulation  is  nowhere  shown  to  better  ad- 
vantage than  in  the  group  of  choleras,  Asiatic,  morbus  and  in- 
fantile. \Yhen  the  stage  of  collapse  has  supervened,  nothing  equals 
capsicum  in  arousing  the  vitality  and  restoring  warmth  to  the  skin. 
Full  doses  must  be  given,  the  tincture,  undiluted,  being  advisable. 
For  here  the  admonition  of  the  Hindoo  doctors  is  wise — if  you  can 
give  a  dose  strong  enough  to  bring  the  tears  to  the  eyes  the  patient 
will  be  saved.  And  this  principle  comes  in  as  applicable  to  the  first 
onslaught  of  the  malady,  as  well  as  in  dysenteries  and  the  chills 
of  opening  fever  attacks. 

The  same  is  applicable  to  angina  pectoris,  whose  paroxysms 
may  be  broken  by  a  single  dose  of  capsicum  if  strong  enough.  The 
timid  practician  is  out  of  place  here — it  is  the  sledge-hammer  blow 
alone  that  will  save  life. 

In  the  debility  of  advancing  age,  with  tired,  aching  muscles,  stiff 
joints  and  general  relaxation,  capsicum  is  of  much  value.  Here  is 
the  place  for  it  as  a  condiment,  for  those  who  have  wisely  refrained 
from  its  use  in  earlier  days.  Give  enough  for  the  work. 

In  pneumonias,  debilitated  cases,  where  there  is  a  threatening 
of  the  affected  pulmonary  tissues  falling  into  abscess,  capsicum  in 
large  doses  may  arrest  the  process. 

In  flatulence,  Capsicum  should  be  added  to  the  aloin,  strychnine, 
eserine  or  berberine,  and  from  these  an  effective  formula  may  be 
made  up. 

In  some  cases  of  persistent  vomiting,  it  seems  as  if  the  stomach 
requires  a  lesson — for  in  what  other  way  can  we  explain  the  credit 
the  following  "antiemetic  drops"  possess?  One-half  oz.  powdered 


134  CAULOPHYLLIN 

capsicum,  two  drams  of  salt,  y2  pint  each  of  vinegar  and  water ;  dose 
a  tablespoonful. 

In  various  spasmodic  maladies  capsicum  has  proved  effective; 
full  doses  with  as  little  dilution  as  possible  are  best. 

For  passive  hemorrhages,  especially  uterine,  capsicum  has  been 
advocated;  and  associated  with  ipecacuanha  in  postpartum  cases. 

Locally,  capsicum  has  been  recommended  as  a  gargle  in  scarlet 
fever  and  in  chronic  tonsillitis ;  as  an  application  to  stimulate  slug- 
gish ulcer& ;  for  chronic  ophthalmia,  where  the  use  is  as  apt  as  that 
of  abrus  (jequirity),  and  indubitably  less  dangerous;  for  corneal 
ulcers,  where  the  vitality  of  the  tissues  must  be  sustained  at  any 
cost ;  to  abort  acute  tonsillitis,  used  very  early ;  for  the  hoarseness  of 
atony  of  the  vocal  apparatus ;  for  relaxed  uvula ;  chilblains ;  tooth- 
ache; cold  feet;  in  any  case  where  it  is  advisable  to  stimulate  the 
vitality,  or  to  increase  the  action  of  other  drugs — the  latter  apply- 
ing to  local  or  internal  use  equally. 

The  specific  indications  for  the  use  of  capsicum  are  thus  summed 
by  King:  Great  depression  and  debility;  atonic  dyspepsia  of 
drunkards;  delirium  tremens;  colic  with  flatulence;  congestive 
chills ;  cold  feet ;  white  lips,  small  pulse,  capillary  atony,  tongue  dry ; 
chronic  hemorrhoids. 

For  most  of  its  uses  the  oleoresin  of  capsicum  is  eligible ;  in 
doses  of  gr.  1-20  to  a  grain,  before  meals  or  as  indicated.  When  it 
is  desired  to  powerfully  affect  the  stomach  and  solar  plexus,  as  in 
congestive  chills,  a  grain  or  more  may  be  given  in  a  teaspoon ful  of 
alcohol.  For  cold  feet  powdered  capsicum  may  be  put  in  the  stock- 
ings. The  red  pepper  of  the  grocer  is  rarely  if  ever  undiluted,  and 
that  of  the  pharmacist  is  not  much  better.  If  the  physician  will  take 
the  trouble  to  secure  a  supply  of  a  pure  article  he  will  be  surprised 
to  find  what  a  difference  exists. 

CAULOPHYLLIN. 

Standard  granule — Gr.  1-6,  gm.  .01. 

Caulophyllin  is  a  concentration  from  the  rhizome  and  roots  of 
Caulophyllum  thalictroides,  the  blue  cohosh,  squaw  root,  or  papoose 
root. 

The  virtues  of  this  plant  depend  on  a  crystalline  glucoside 
isolated  by  Lloyd,  and  by  him  named  leontin.  It  is  slightly  soluble 
in  cold  and  very  soluble  in  hot  alcohol,  insoluble  in  water  or  in 
chloroform.  Alkaline  watery  solutions  dissolve  it  perfectly.  The 


CAULOPHYLLIN  135 

solutions  are  acrid  and  irritating.  Of  the  caulophyllin  of  the  market 
Lloyd  says:  "Like  nearly  all  the  so-called  concentrations  and  res- 
inoids  of  early  Eclectic  preparation,  while  they  were  better  agents 
than  preceding  pharmacal  products,  yet  at  the  present  time  they  are 
too  uncertain  in  composition  and  medicinal  value  to  hold  a  leading 
place  among  our  more  modern  therapeutic  preparations."  And  that 
tells  the  story  of  the  alkaloids,  which,  however,  this  great  chemist  is 
not  yet  ready  to  accept. 

Therapeutics. — Caulophyllum  was  introduced  by  Rafinesque  as  a 
powerful  emmenagog;  the  Indians  used  it  in  rheumatism,  dropsy, 
colic,  sore  throat,  cramp,  hiccough,  epilepsy,  hysteria,  metritis,  etc. 
King  applied  it  for  aphthous  stomatitis.  Scudder  believed  it  in- 
fluenced the  hypogastric  plexus,  affecting  the  circulation,  nutrition 
and  functions  of  the  reproductive  apparatus.  Lloyd  describes  it  as 
antispasmodic,  diaphoretic  and  diuretic,  expectorant,  emmenagog  and 
parturifacient.  The  Indians  gave  it  some  weeks*  previous  to  con- 
finement to  facilitate  labor.  During  labor  it  relieves  false  pains  and 
coordinates  true  ones,  increasing  their  force.  It  is  a  better  oxytocic 
than  ergot,  stimulating  normal  contraction's  instead  of  inducing 
spasmodic  action.  It  is  best  when  delay  is  due  to  debility,  fatigue 
or  lack  of  nervous  energy,  and  when  with  weak  pains  the  tissues  feel 
full  and  congested.  He  advises  it  for  several  weeks  before  labor, 
for  delicate  women  or  those  who  have  prolonged  and  difficult  labors. 
Hale  says  those  who  take  caulophyllin  thus  may  overrun  their  time 
by  12  days,  but  have  very  easy  labors  and  make  good  recoveries. 

Felter.  and  Lloyd  enumerate  the  following  conditions  in  which 
caulophyllin  gives  benefit :  After-pains,  especially  spasmodic ;  hour- 
glass contraction,  spurious  labor-pains ;  antiabortive  by  relieving  the 
irritation  on  which  the  trouble  depends ;  irritation  of  the  reproduc- 
tive organs  resembling  congestion,  chronic  inflammations  and  de- 
bility; uterine  tenderness  and  pain  with  debility;  to  overcome  at- 
tacks of  hysteria,  relieve  ovarian  or  mammary  pain,  or  irritation,  in 
hysteria;  chronic  endometritis  or  metritis,  ovaritis,  ovarian  neu- 
ralgia, uterine  leucorrhea,  amenorrhea  and  dy&menorrhea ;  uterine 
rheumatism  with  nervous  excitement,  menstrual  cramps  and  menor- 
rhagia  due  to  subinvolution ;  chorea  and  epilepsy  with  maladies  of 
the  sexual  organs,  flatulent  and  spasmodic  colic,  cramps;  obstinate 
hiccough;  its  antispasmodic  effects  are  permanent;  lessens*  irrita- 
tion in  cystitis,  urethritis,  chronic  nephritis,  spasmodic  retention  of 
urine,  when  crampy  pains  in  stomach  follow  eating  in  rheumatics; 
rheumatism  of  small  joints,  asthenic  plethora  and  its-  rheumatic 


136  CAULOPHYLLIN 

pains ;  insomnia,  bronchitis  and  catarrhal  pneumonia  as  a  sedative : 
orchialgia;  gastric  nausea  and  vomiting.  Leontin  has  been  used 
with  benefit  in  the  amenorrhea  and  dysmenorrhea  of  chlorosis. 

Specific  Indications. — Uterine  pains,  fullness  and  weight;  pain 
in  legs;  fullness  of  tissues  as  if  congested;  irritable  debility  of  the 
nervous  system  with  muscular  weakness ;  spasmodic  muscular  pains, 
articular  pains,  rheumatic  pains  of  asthenic  plethora,  epigastric  and 
umbilical  colicky  pains ;  dull  frontal  headache ;  great  thirst ;  as  an 
oxytocic ;  false  pains  and  uterine  irritability ;  sexual  erethism ; 
spasmodic  uterine  contractions ;  dysmenorrhea ;  irregular  menstrua- 
tion ;  stomach  cramps  after  eating ;  pain  in  toes  and  fingers  not  due 
to  tissue  changes. 

Ellingwood  says  this  remedy  must  be  continued  long  to  obtain 
its  benefits.  The  last  three  months  of  pregnancy  constitute  its  great 
field. 

Gestation  being  prolonged  the  fetus  is*  fully  developed  and  labor 
normal.  He  gives  caulophyllum  with  confidence  for  the  amenor- 
rhea at  the  beginning  of  menstrual  life ;  to  control  congestion  in 
whooping-cough ;  moth  patches  on  the  face ;  rigid  os ;  atonic  hemor- 
rhagic  tendency  after  labor ;  dysmenorrhea  or  lack  of  development ; 
dropsy  with  menstrual  disorders.  It  is  given  every  ten  minutes  till 
labor  pains  become  sufficient. 

Dr.  E.  J.  Meacham  verifies  these  statements'  as  to  the  value  of 
caulophyllin  in  labor,  and  tells  of  a  case  in  which  there  was  active 
labor  with  the  soft  parts  hard  and  resisting  dilation.  It  was  a  primi- 
para.  He  gave  caulophyllin  gr.  1-6  every  fifteen  to  thirty  minutes 
and  soon  found*  the  os  soften  and  dilate. 

The  eclectic  school  is  practically  unanimous  as  to  the  value  of 
this*  drug,  and  as  to  the  conditions  in  which  it  is  indicated.  It  seems 
unlikely,  to  say  the  least,  that  all  this  testimony  is  mistaken  and  that 
caulophyllin  is  unworthy  a  place  in  modern  medicine.  Cushny  at- 
tributes any  virtues  it  may  possess  to  its  saponine  and  Shoemaker 
refers  to  this  agent  some  expectorant  properties'  which  he  attributes 
to  blue  cohosh.  The  limited  uses  made  of  caulophyllin  by  the  writer 
have  been  sufficient,  however,  to  convince  him  that  it  is  an  active 
agent  and  so  far  as  this  experience  goes,  to  confirm  Ellingwood's 
recommendation.  The  concentration  caulophyllin  fully  represents 
the  plant's  therapeutic  powers,  though  leontin  should  be  still  better 
if  it  can  be  procured  and  handled  commercially. 

In  acute  conditions-  caulophyllin  should  be  given  in  doses  of  gr. 


CEPHAELINE.     CERIUM   OXALATE  137 

1-6  every  ten  minutes,  dissolved  in  hot  water,  till  effect.  In  chronic 
conditions  give  a  grain  four  times  a  day,  in  granules  to  allow  slow 
absorption. 

CEPHAELINE. 

In  1894  Paul  and  Cownley  succeeded  in  separating  emetine 
(total  alkaloid  from  ipecac)  into  two  components — Cephaeline,  and 
an  alkaloid  for  which  they  retained  the  name  "Emetine."  The 
formula  C13  H22  NO2  has  been  assigned  to  the  cephaeline,  and  C,, 
H20  NO3  to  the  emetine  of  these  investigators. 

R.  B.  Wild  (Pharm.  Jour.,  1895,  P  435)  nas  made  careful  phar- 
macologic  experiments  with  cephaeline.  He  finds  that  5  milligrams 
(1-12  grain)  produce  nausea,  slight  dizziness,  salivation,  and 
retching  but  not  actual  vomiting ;  at  the  same  time  the  arterial  pres- 
sure is  somewhat  diminished.  A  dose  of  10  milligrams  (1-6  grain) 
produces  similar  effects,  followed  in  an  hour  by  violent  vomiting; 
occasionally  intestinal  peristalsis  is  increased,  a  soft  stool  resulting. 
No  appreciable  influence  on  the  nasal  mucosa,  skin  or  urinary 
system  has  been  observed,  and  the  vomited  matter  does  not  contain 
an  excess  of  bile.  Furthermore,  cephaeline  is  reported  to  have  but 
a  moderately  toxic  action  on  the  voluntary  muscles ;  the  walls  of  the 
blood-vessels  are  not  excessively  contracted,  and  the  nervous  supply 
of  the  heart  is  also  not  affected  in  an  unusual  degree." 

The  cost  of  cephaline  precludes  its  employment,  as  emetine  in 
large  doses  appears  to  cover  its  uses.  Granules  of  gr.  1-134  each 
would  cost  about  i  cent  apiece. 

CERIUM    OXALATE. 

Standard  granule — Gr.  1-6,  gm.  .01. 

Cerium  oxalate  was  introduced  by  Sir  James  Y.  Simpson,  as  a 
remedy  for  the  vomiting  of  pregnancy.  It  is  white,  odorless  and 
tasteless ;  insoluble  in  water  or  in  alcohol.  Large  doses  cause  dry- 
ness  of  the  mouth.  Cushny  says  it  depresses  the  heart,  causes  vomit- 
ing and  purging,  with  hyperemia  and  ecchymoses  of  the  stomach 
and  bowels,  nephritis  and  congestion  of  the  kidneys,  when  adminis- 
tered intravenously.  Shoemaker  pronounces  it  a  sedative  to  the 
gastric  mucosa. 

This  salt  has  held  a  precarious  place  as  a  remedy  for  the  vomit- 
ing of  pregnancy,  opinions  varying  as  to  its  efficacy.  Those  who 
look  on  this  ailment  as  a  disease  to  be  treated  per  se,  will  not  sue- 


138  CETRARIN 

ceed  with  it.  But  when  the  bowels  have  been  regulated,  the  func- 
tion of  the  kidneys  brought  up  to  the  full  measure  of  efficacy,  and 
rhagades  and  other  affections  of  the  uterus  properly  treated,  the 
oxalate  of  cerium  will  prove  the  best  of  the  direct  gastric  sedatives. 

But  if  inflammatory  or  other  irritations  of  the  stomach  are  the 
cause  of  the  vomiting  it  is  doubtful  if  this  remedy  will  give  relief. 
Hare  speaks  of  it  as  a  remedy  for  acidity.  Shoemaker  says  it  has 
been  given  for  vomiting  of  uterine  disease,  and  even  of  gastric 
cancer;  as  well  as  for  the  obstinate  vomiting  of  typhoid  fever  and 
that  of  phthisis.  The  nausea  attending  the  administration  of  opiates 
has  been  relieved  by  cerium.  Image,  who  recommended  it  highly 
in  uterine  vomiting,  says  failure  is  due  to  the  use  of  too  small  doses. 
He  gave  gr.  x,  repeated  every  hour. 

Clarke  and  Morje  found  cerium  serviceable  in  whooping-cough, 
lessening  the  severity  and  the  frequency  of  the  paroxysms.  Shoe- 
maker speaks  of  its  value  in  the  severe  cough  of  phthisis,  or  of 
chronic  bronchitis.  It  has  also  been  used  with  benefit  for  the 
dyspnea  due  to  deficient  innervation  of  the  stomach,  and  in  chronic 
diarrhea.  Less  certain  is  its  use  in  chorea,  epilepsy  and  dysmenor- 
rhea. 

Simpson  gave  the  nitrate  for  irritative  dyspepsia  with  gastro- 
dynia  and  pyrosis. 

The  fact  seems  to  be  that  the  oxalate  of  cerium  is  a  direct  seda- 
tive to  the  stomach  mucosa,  not  suited  to  cases  of  acute  inflamma- 
tion or  irritation.  This  irritability  may  be  due  to  autotoxemia,  to 
deficient  renal  elimination,  or  to  cerebral  irritability.  In  which  of 
these  is  cerium  indicated?  It  has  seemed  to  exert  a  direct  sedative 
effect  on  the  gastric  terminals  of  the  vagus.  More  accurate  observa- 
tions should  be  had  to  determine  why  this  remedy  which  acts  so 
brilliantly  is  some  cases  fails  in  others  apparently  similar. 

Image  recommended  that  the  first  dose — of  gr.  v — should  be 
taken  before  rising,  and  found  three  doses  a  day  usually  sufficient. 
This  is  best  for  vomiting  of  pregnancy,  and  for  gastralgia.  In 
acidity  and  other  forms  of  recurrent  vomiting,  a  smaller  dose,  gr. 
1-6  to  j,  repeated  every  five  to  fifteen  minutes  gives  better  results. 
Wood,  who  is  a  megalodoser,  gives  five  grains  every  hour. 

CETRARIN. 

From  Iceland  moss  is  derived  cetrarin,  or  cetraric  acid,  C18  H16 
O8,  an  intensely  bitter  principle  forming  hairlike  needles.  The  moss 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


CHELIDONIN  139 

is  treated  with  petrol-ether,  precipitated  with  potassium  carbonate 
and  purified  with  hydrochloric  acid.  Cetrarin  is  insoluble  in  water, 
slightly  in  ether  or  cold  alcohol,  readily  in  boiling  alcohol,  in  alka- 
lies and  their  carbonates. 

Merck  terms  cetrarin  a  hematinic,  stomachic  and  expectorant, 
useful  in  chlorosis,  where  it  increases  the  number  of  red-blood  cells ; 
also  in  incipient  phthisis,  bronchitis,  and  digestive  disturbances  with 
anemia. 

Dose,  o.i  to  2.0. 

Robert  states  that  cetraric  acid  increases  intestinal  peristalsis, 
and  augments  the  number  of  both  red  and  white  blood-cells,  espe- 
cially when  they  have  been  diminished  by  disease.     It  slightly  stim- 
ulates the  central  nervous  •  system,  and  increases  the  secretion  of 
saliva,  bile  and  pancreatic  fluid. 

In  Iceland  the  moss  is  employed  as  a'  prophylactic  against 
elephantiasis.  Eckfeldt  recommended  cetraric  acid  as  a  remedy  for 
hemoptysis,  and  it  has  also  been  applied  locally  for  epistaxis  and  for 
spongy  gums. 

As  Merck  lists  cetrarin  at  75  cents  a  gram,  it  is  obviously  beyond 
the  reach  of  ordinary  patients.  Nor  does  it  seem  to  be  necessary 
to  employ  this  principle,  as  probably  all  the  benefit  it  affords  will 
accrue  from  the  use  of  Iceland  moss  as  a  food.  This  can  be  pre- 
pared as  a  jelly,  flavored  to  suit  the  taste,  with  sugar,  salt,  or  lemon ; 
or  as  a  beverage.  But  it  is  important  to  know  that  this  rarely  used 
food  contains  such  valuable  remedial  properties. 

In  pernicious  and  intractable  forms  of  anemia  the  cost  may  be 
disregarded,  and  this  substance  may  prove  most  valuable  at  a  period 
when  other  remedies  fail. 

CHELIDONIN. 

Chelidonium  majus,  the  greater  celandine,  is  one  of  those  plants 
that  is  continually  being  brought  forward  as  a  remedy,  insufficiently 
tested,  and  allowed  to  drop  back  into  obscurity.  In  this  case  it  is  as 
a  remedy  for  cancer  that  it  is  advocated. 

Closely  related  to  the  poppy,  chelidonium  rivals  that  storehouse 
of  remedial  agents  in  the  number  of  active  principles  it  contains. 
Schmidt  announced  that  in  celandine  he  found  no  less  than  12  bases! 
Among  these  were  chelerythrine,  chelidonine,  chelidoxanthine,  and 
protopine.  Concerning  the  properties  of  these  principles  our  in- 
formation is  scantv  and  uncertain.  Chelerythrine  is  said  to  be 


140  CHELIDONIN 

identical  with  sanguinarine,  which  it  closely  resembles  in  physical 
properties.  But  this  identity  has  been  denied.  Such  assertions 
should  always 'be  taken  with  distrust.  Identity  of  ultimate  or  of 
elementary  composition  is  not  necessarily  identity  of  effect.  Even 
in  the  case  of  theine,  which  Merck  asserts  to  be  identical  with  caf- 
feine, so  good  an  observer  as  Mays  finds  a  decided  difference  in 
their  therapeutic  effects.  Scopolamine  is  asserted  to  be  identical 
with  hyoscine,  and  this  also  is  denied. 

Merck  gives  the  following  data  as  to  chelerythrine :  Soluble  in 
alcohol,  ether,  chloroform,  benzine  and  petroleum  oils ;  a  cardiac 
poison.  Sanguinarine  is  soluble  in  chloroform,  amylic  alcohol, 
benzine,  alcohol  and  ether;  stimulant,  tonic,  expectorant,  purgative, 
emetic;  dose  gr.  1-12  to  1-4.  Poison!'  The  nitrate  is  soluble  in 
water  and  in  alcohol.  Chelidonine  is  an  alkaloid,  white,  crystalline, 
soluble  in  alcohol,  chloroform,  very  slightly  in  ether,  insoluble  in 
water;  non-toxic;  narcotic,  resembling  morphine  but  less*  stimulat 
ing,  slightly  stimulating  the  spinal  cord. 

Therapeutics. — Ribbing  and  Ruempf  used  chelidonin  in  gastric 
ulcer,  cancer  and  enteralgia,  in  doses  of  2  to  5  centigrams.  The  re- 
sults were  quite  satisfactory,  in  some  cases  even  excellent.  One 
advantage  over  opiates  is  that  chelidonin  produced  no  trace  of 
heaviness,  somnolence,  constipation  or  other  concomitant  phe- 
nomena. Especially  in  infantile  practice  chelidonin  was  accorded 
preference  over  opium  for  its  innocuity.  With  adults  the  dose  of 
chelidonin  is  o.io  to  2.0  or  more. 

It  possesses  calmative  and  hypnotic  properties,  while  being  less 
narcotic  than  the  other  alkaloids  obtained  from  plants  of  the  same 
family,  such  as  the  opium  derivatives.  It  is  precisely  this  small 
degree  of  toxicity  that  indicates  the  use  of  chelidonin  in  certain  pain- 
ful affections  of  the  stomach  and  bowels. 

Robinson  made  injections  of  chelidonin  in  a  woman  presenting 
a  malignant  tumor  of  the  superior  maxilla  with  large  intrabuccal 
ulceration.  Three  hours  after  the  injection  reaction  followed,  in- 
tense, with  shivering,  but  next  day  the  tumor  began  to  soften.  The 
dose  was  increased  and  the  tumor  bathed  twice  daily  with  ext. 
chelidonium  with  an  equal  part  of  glycerin.  The  tumor  has  con- 
tinued to  decrease  and  is  no  longer  inflamed.  He  deduces  a  specific 
action  of  chelidonin  on  malignant  tumors. 

Ivanow  cites  the  case  of  a  woman  aged  53,  with  gastric  cancer, 
treated  by  chelidonin  internally.  Her  condition  was  one  of  pro- 
found marasmus  with  violent  pains  in  the  stomach,  vomiting  all  food 


CHELIDONIN  141 

so  persistently  that  rectal  feeding  was  necessitated.  The  vomitus 
had  the  appearance  of  coffee  grounds;  the  liver  wa&  enlarged,  the 
left  lobe  prominent.  The  existence  of  a  malignant  neoplasm  was 
beyond  doubt.  Under  the  influence  of  chelidonin  she  improved 
rapidly,  the  vomiting  that  had  persisted  for  three  months  ceased  in 
fifteen  days,  the  tenderness  of  the  tumefaction  as  well  as  the  gastric 
dilatation  subsided  and  the  appetite  returned.  Soon  she  could  feed 
herself  by  the  mouth  and  get  up;  she  suffered  no  longer  and  re- 
turned to  her  occupation. 

A  lively  reaction  followed  the  administration  of  this  medicament. 
The  observed  phenomena,  local  and  general,  have  a  characteristic 
clinical  significance.  The  reaction  had  a  certain  general  resemblance 
to  that  provoked  by  tuberculin.  There  was  a  sense  of  weakness, 
shivering,  a  little  fever,  38  to  39  C,  the  progressive  disappearance 
of  the  earthy  tint  of  the  skin,  softening  and  subsidence  of  the  tumor. 
The  pains  are  gone,  the  general  state  good,  lassitude  disappeared, 
sleep  restored,  the  aspect  of  the  neoplasm  improved,  the  patient 
feels  herself  much  relieved  and  the  inflammation  retrogrades  from 
day  to  day. 

Observations  of  Denissenko,  Ivanow,  Kraisky  and  Meyer  in- 
dicate the  employment  of  chelidonin  in  gastric  cancer,  cancroids  of 
the  lids  and  lips,  epitheliomas,  malign  neoplasms  and  all  malignant 
tumors  external  and  internal. 

In  gastric  ulcer  and  cancer,  enteralgias,  cancer  of  the  bowels  or 
larynx  and  in  hepatic  tumors,  the  results  of  the  treatment  have  been 
very  favorable  and  rapid,  the  tumor  continuing  to  diminish,  the  in- 
flammation arrested,  amelioration  has  been  manifest  and  the  cure 
often  appears  definitive. 

In  laryngeal  cancer  chelidonin  has  given  very  encouraging  re- 
sults, when  employed  locally  by  lotions  and  internally.  Under  its 
influence  the  pains  of  deglutition  and  the  respiratory  difficulty 
vanish  and  the  general  condition  is  promptly  and  considerably 
ameliorated. 

Chelidonin  may  be  given  in  very  large  doses  without  harm. 
Houde  advises  0.002  (gr.  1-30)  six  to  eight  times  a  day  or  twelve 
times  in  old  cancerous  diatheses.  It  is  well  tolerated.  In  gastralgia, 
enteralgia,  etc.,  when  only  the  calmant  and  hypnotic  effect  is  de- 
sired, the  doses  need  not  be  so  large.  For  lotions  and  hypodermic 
injections  he  advises  i-iooo  solutions. 


142  CHIMAPHILIN 

CHIMAPHILIN. 

Standard  granule — Gr.  1-6,  gm.  .01. 

Chimaphilin  is  a  concentration  from  the  leaves  of  Chimaphila 
umbellata,  pipsissewa,  prince's  pine,  ground  holly,  or  wintergreen. 
The  active  principles  are  arbutin,  chimaphilin  and  several  others  not 
yet  studied.  The  remedial  virtues  accredited  to  this  plant  are  those 
of  arbutin.  It  has  also  a  volatile  ingredient,  as  the  infusion  is  said 
to  possess  a  value  that  is  lost  in  the  decoction. 

Felter  and  Lloyd  credit  pipsissewa  with  diuretic,  tonic,  alterative 
and  astringent  properties.  It  increases  waste  and  affects  nutrition. 
It  is  used  in  scrofula  and  in  chronic  rheumatic  and  genitourinary 
affections.  It  relieves  irritation  of  any  part  of  the  genitourinary 
tract,  and  improves  the  nutrition  of  the  affected  tissues.  Its  special 
field  is  in  genital  discharges  with  debility  or  scrofula.  Cystitis  with 
offensive  urine,  and  urine  loaded  with  mucus,  muco-pus  or  blood, 
are  benefited.  Chronic  pyelitis  is  also  favorably  influenced  by 
pipsissewa,  as  well  as  chronic  prostatitis,  scrofulous  ulcers,  ascites, 
strangury,  gleet,  lithemia,  etc. 

Specific  Indications. — Atony  of  the  genitourinary  organs,  with 
lingering  disorders,  scanty  urine,  profuse  mucus,  pus  or  blood  in 
urine,  dysuria  with  smarting  or  burning  pain,  chronic  irritation  of 
urethra  or  prostate,  relaxation  of  bladder  walls,  chronic  prostatitis 
with  vesical  catarrh, 

Ellingwood  says  chimaphila  aids  in  restoring  the  excretory  func- 
tions- to  a  normal  condition  and  removes  irritation  of  the  urinary 
tract,  lesions  of  the  skin  and  lymphatic  glands,  and  removes  waste 
matter  from  the  blood,  the  result  of  defective  metabolism.  He  finds 
its  field  in  uricacidemia,  dropsy  with  debility  and  anorexia,  inflamed 
cervical,  mesenteric  or  parotid  glands,  dropsy  after  exanthemata, 
chronic  rheumatism,  hectic  with  nightsweats,  secondary  syphilis, 
hematnria,  gravel,  gout,  nephritis,  the  late  stages  of  typhoid  fever 
with  deficient  excretion,  and  mammary  tumors  supposed  to  be  can- 
cerous. For  acute  rheumatism  he  advises  a  warm  infusion  to  be 
given  till  it  causes  perspiration,  and  the  same  applied  to  the  affected 
joints. 

Any  virtues  not  due  to  the  volatile  ingredient  may  be  much  more 
easily  obtained  by  the  use  of  arbutin.  Like  it,  pipsissewa  blackens 
the  urine. 

The  dose  of  chimaphilin  is  a  grain  before  meals  and  at  bedtime. 


CHTONANTHIX.     CICUTINE  143 

CHIONANTHIN. 

Standard   granule — Gr.   1-67. 

Chionanthin  is  derived  from  the  bark  of  the  root  of  Chinonan- 
thus  Virginica  (fringe-tree).  The  shrub  is  a  native  of  the  south- 
eastern states  and  its  medicinal  qualities  have  been  recognized 
popularly  for  a  long  time. 

The  eclectics  regard  this  remedy  with  favor  and  it  is  unques- 
tionably a  most  valuable  hepatic  stimulant  and  alterative.  Chionan- 
thin is  aperient,  diuretic,  febrifuge,  cholagog  and  purgative.  Its 
tonic  and  alterative  action  is  also  marked  if  dosage  is  continued.  In 
fact,  it  is  as  a  continued  remedy  for  chronic  engorgements  and  slug- 
gish liver  that  it  has  most  value.  In  full  doses  (2  to  5  grains)  it 
has  a  pronounced  cholagog  action  and  may  be  given  in  extreme 
conditions  with  podophyllin.  But  its  main  utility  is  as  an  alterative 
hepatic  in  jaundice,  bilious  conditions  and  catarrhal  states  of  the 
bile-ducts.  Then  it  should  be  given  in  doses  of  from  gr.  1-6  to  gr. 
1-2,  preferably  after  meals,  three  times  daily.  In  a  few  days  the 
skin  clears,  the  patient  feels  brighter  and  his  appetite  returns.  It 
seems  to  have  a  specific  action  in  overcoming  catarrh  of  the  ducts, 
promotes  the  flow  of  bile  and  prevents  the  formation  of  calculi. 

In  any  acute  congestion  of  the  liver  this  is  the  remedy  of  choice 
and  should  be  given  in  full  doses  followed  by  sodium  phosphate  or 
other  saline  laxative.  The  jaundice  of  childhood  rapidly  yields  to 
this  remedy  as  does  that  of  pregnancy.  In  all  malarial  conditions 
it  is  to  be  thought  of  and  may  be  given  during  either  the  chill  or 
fever  with  equally  beneficial  results.  The  author  has  found  it  in 
doses  of  gr.  l/^  three  times  daily  unequalled  for  restoring  to  healthy 
activity  the  livers  of  sedentary  workers.  It  may  be  combined  with 
iridin,  euonymin,  leptandrin  or  podophyllin.  It  is  a  remedy  which 
should  be  more  used  than  it  is. 

CICUTINE. 

Standard  granule— Gr.  1-134,  gm.  .0005:  cicutine  hydfobromate,  gr.  1-67, 
gm.  .001. 

The  use  of  conium,  celebrated  in  antiquity,  has  fallen  into 
oblivion  in  most  countries,  on  account  of  the  uncertainty  and  general 
worthlessness  of  its  galenic  preparations.  Dragendorff  found  in  the 
leaves  and  fresh  bark  0.0466  to  0.094  per  cent  of  cicutine ;  in  dried 
leaves  0.26  per  cent,  and  in  seeds  gathered  before  maturity  o.-<Vj 


144  CICUTINE 

per  cent.  Holmes  found  no  toxic  properties  in  the  Scotch  hemlock. 
Close  could  isolate  only  0.0003  per  cent  of  active  principle  from  the 
ordinary  dried  leaves  of  the  pharmacy.  Von  Schroff  observed  no 
toxic  results  from  doses  of  30  to  60  grains  of  the  extract  given  to 
rabbits.  At  Dixmont  we  used  the  extract  as  a  pill  excipient  in  1872. 
Such  observations  suffice  to  condemn  the  remedy  as  far  as  con- 
cerns the  galenic  preparations  and  the  crude  plant. 

Cicutine  is  a  liquid,  lighter  than  water,  readily  decomposing  in 
air,  and  volatile.  It  is  more  soluble  in  cold  than  in  hot  water ;  and  is 
quite  soluble  in  alcohol,  ether,  chloroform,  acetone,  benzole  and  the 
essential  oils.  The  alkaline  reaction  is  strong,  even  replacing  am- 
monia. The  salts  of  cicutine  are  quite  permanent  and  free  from  ob- 
jection, and  these  are  preferable.  The  hydrobromate  is  in  the  form 
of  small  colorless  rhombic  prisms,  resisting  the  air,  soluble  in  water, 
containing  60.7  per  cent  of  cicutine.  It  may  be  used  subcutaneously, 
while  cicutine  is  irritant. 

Physiologic  and  Toxic  Actions. — To  the  mucosa  cicutine  is  ir- 
ritant, but  solutions  applied  to  the  skin  produce  anesthesia.  In 
ancient  times  the  hierophant  presiding  over  the  Eleusinian  mysteries 
is  said  to  have  applied  conium  to  the  genitals  of  initiates1  to  render 
easier  the  fulfillment  of  vows  of  chastity.  In  the  eye  the  first  irrita- 
tion is  great  and  the  subsequent  anesthesia  correspondingly  pro- 
found. 

Cicutine  is  eliminated  by  the  urine,  the  lungs,  and  in  part  broken 
up  in  the  body. 

The  predominant  action  of  cicutine  is  paralysant,  at  first  of  the 
terminal  extremities,  then  of  the  trunks,  of  the  motor  nerves.  At 
first  limited  to  the  voluntary  muscles,  it  extends  to  those  of  respira- 
tion, the  left  heart,  next  to  the  diaphragm,  and  finally  causes  death 
by  asphyxia,  the  preceding  dyspnea  accompanied  by  clonic  spasms. 
The  heart-action  remains  long  unaffected  if  deoxidation  is  prevented 
by  forced  respiration.  Consciousness  remains  unaffected  to  the  last. 
There  is  probably  a  special  action  on  the  spinal  centers,  since  reflex 
action  is  lost  before  the  irritability  of  the  peripheral  nerves  ceases. 

One-fourth  of  a  drop  of  cicutine  taken  in  the  mouth  of  a  healthy 
man  causes  a  sense  of  burning  to  the  tongue,  slight  constriction  of 
the  throat,  flow  of  saliva,  nausea  and  vomiting,  general  malaise  and 
heat  of  the  head.  A  drop  produces  alarming  symptoms,  such  as 
vertigo,  impossibility  of  fixing  the  thoughts  or  the  attention,  som- 
nolence, malaise  very  marked,  ocular  troubles,  dilated  pupils,  altera- 
tions of  touch  and  hearing,  tremors,  weakness,  gait  uncertain  and 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


CICUTINE  145 

vacillating,  cyanosis,  cold  sweats,  finally  spasmodic  muscular  con- 
tractions when  the  muscles  are  forced  to  move.  The  pulse  is  small 
and  weak,  a  slight  primary  rapidity  being  soon  followed  by  slower 
pulsations. 

Burggrseve  reports  the  following  effects  when  taking  cicutine: 
Tendency  to  repose  and  slumber,  without  fatigue,  quite  different 
from  that  of  morphine;  waking  calm,  without  headache ;  softening 
of  the  pulse;  notable  diuresis  and  diaphoresis.  It  is  evident  how 
cicutine  calms  the  pains  of  cancer  and  restores  the  forces  by  sleep. 

Eulenberg  mentions  a  sense  of  weakness  and  vertigo  after  a  sub- 
cutaneous dose  of  gr.  1-67  but  double  this  dose  did  no  harm  to  the 
same  patient. 

In  warm-blooded  animals  the  effects  of  cicutine  are  manifested 
a  minute  or  two  after  taking,  by  general  paralysis,  beginning  some- 
times with  the  anterior,  sometimes  with  the  posterior  extremities ; 
the  respiration  at  first  irregular  is  arrested,  the  heart  continuing  to 
beat  for  hours.  If  the  dose  is  not  fatal  the  animal  recovers*  within 
twenty-four  hours.  Ligation  of  the  iliac  artery  prevents  paralysis 
of  that  limb.  The  only  convulsions  occurring  are  the  clonic  ones 
with  asphyxia.  Fibrillary  muscular  contractions  from  the  first  are 
probably  due  to  a  primary  excitation  preceding  the  peripheric  motor 
paralysis.  During  the  paralytic  period  the  sensorium  and  sensation 
are  unaffected. 

Cicutine  exerts*  its  effects  on  the  nervous  centers,  since  ligation 
of  all  the  vessels  of  the  extremities  does  not  prevent  the  dimfnution 
of  reflex  sensibility.  The  psychomotor  centers  appear,  however,  to 
be  only  affected  secondarily,  and  from  the  deprivation  of  oxygen 
or  the  alteration  of  intravascular  pressure.  The  lachrymal,  salivary 
and  renal  secretions  are  increased  by  cicutine,  but  Prevost  denies  the 
direct  influence  on  the  sensory  and  secretory  nerves.  Jolye't  and 
Pelissard  have  demonstrated  the  paralyzant.  action  of  cicutine  on  the 
pneumogastric  nerve-ends,  showing  vefy  quickly  and  after  doses 
too  light  to  paralyze  the  motor  nerve-ends. 

The  intravascular  pressure  and  the  animal  heat  are  increased, 
even  after  medicinal  doses.  The  respiratory  movement  in  grave 
poisoning  is  at  first  accelerated  and  convulsive,  then  retarded.  The 
respiratory  mechanism  is  not  disturbed  by  light  doses,  which  cause 
only  irregular  and  paretic  rhythm.  Mydriasis  is  a  pretty  constant 
sign  ;  rarely  the  opposite  effect  is  seen. 

Intestinal  peristalsis  persists  even  after  death. 


146  CICUTINE 

,  > 

Ihmsen  reported  changes  in  the  blood,  but  this  is  denied  by 
Huesemann. 

Binz  reports  an  interesting  case  of  poisoning  with  half  an  ounce 
of  the  fluid  extract  of  conium,  in  a  young  woman  of  feeble  constitu- 
tion. Twenty  minutes  later  she  was  seized  with  nausea  and  vertigo ; 
she  let  fall  what  she  was  holding,  and  could  not  walk.  She  was  put  to 
bed.  The  pulse  rose  to  120  but  was  soon  calmed.  She  was  calm  but 
could  not  execute  the  least  motion  of  her  arms  or  legs.  An  hour 
later  the  paralysis  had  extended  to  nearly  all  the  muscles.  The  eyes 
were  closed,  the  pupils  dilated,  the  brain  perfectly  clear,  calm  but 
active.  Asked  to  open  her  eyes,  she  could  not  move  the  lids*.  Pulse 
and  respiration  normal,  heat  of  the  skin  natural.  After  an  hour  she 
could  open  her  eyes,  and  in  three  hours  motion  was  reestablished. 
Next  day  there  were  only  slight  pains  in  the  muscles  of  the  legs. 
Here  the  heart  and  brain  remained  unaffected ;  but  if  still  larger 
doses  were  taken  paralysis  of  the  diaphragm  would  follow,  with 
cyanosis  and  its  effect  on  heart  and  brain. 

Imbert-Gourbeyre  spoke  of  delirium  and  convulsions  from  hem- 
lock, but  he  probably  used  impure  preparations. 

Since  Ladenburg  in  1886  produced  cicutine  synthetically  it  has 
been  re-tried  with  the  chemically  pure  substance  thus  secured,  and 
the  foregoing  account  of  its  actions  practically  confirmed. 
Respiration  was  first  accelerated,  then  retarded.  The  blood-pressure 
rises  at  first,  then  sinks  to  normal,  and  only  after  large  doses 
does  it*  fall  below  normal.  Cicutine  paralyzes  the  terminals  of  the 
inhibitory  fibers  of  the  pneumogastric  without  preliminary  excita- 
tion. The  cessation  of  breathing  is  not  due  to  paralysis  of  the 
respiratory  center  but  of  the  motor  terminals  in  the  respiratory 
muscles,  especially  those  of  the  phrenic  nerve. 

Synergists. — Van  Renterghem  names  morphine,  atropine,  hyos- 
cyamine,  lobelin.  curarine,  veratrine  and  aconitine,  all  which  dimin- 
ish or  abolish  muscular  irritability,  motor  nerve  conduction,  and  the 
excito-motor  force  of  the  spinal  cord. 

Antagonists. — Strychnine,  brucine  and  picrotoxin  figure.  This 
is  only  relative,  since  strychnine  increases  the  reflex  irritability  of 
the  cord,  while  cicutine  reduces  the  excito-motor  force  of  the 
medulla. 

Tannic  acid  and  potassium  iodide  are  chemical  antidotes. 

Therapeutics. — Van  Renterghem  says  the  Germans,  who  have 
no  active  preparation  of  conium,  find  it  useless;  the  English,  who 
possess  an  active  agent  in  succus  conii,  find  it  of  positive  value. 


.CICUTINE  U7 

In  whooping-cough  its  favorable  action  is  comparable  tp  that  of 
atropine.  Applied  locally  it  lessens  exaggerated  sensibility  and  ex- 
tinguishes the  pain  of  neuralgias  and  of  various  tumors,  even  of 
cancer. 

Binz  found  cicutine  indicated  in  the  tetanus  of  strychnine,  in 
blepharospasm,  and  in  external  neuralgias. 

The  sedative  effect  exerted  by  cicutine  upon  the  spinal  cord  in- 
dicates the  use  of  this  agent  in  all  cases  characterized  by  tonic  con- 
vulsions, contractions,  tetaniform  rigidity,  as  well  as  in  whooping- 
cough,  rabies,  traumatic  and  spontaneous  tetanus,  and  in  poisoning 
by  any  of  the  strychnine  group.  Pereira  states,  however,  that  in 
spite  of  the  cessation  of  the  convulsions,  death  seems  to  be  hastened 
by  the  cicutine.  The  antidotal  value  must  be  decided  by  clinical 
observations. 

Cicutine  is  not  only  hypocinetic,  but  it  is  stupefying  or  anesthetic, 
and  therefore  useful  in  affections  eminently  dolorous.  But  it 
is  in  the  hyperesthetic  and  spasmodic  affections  of  the  respiratory 
apparatus,  which  serves  it  as  a  way  for  elimination,  that  cicutine 
renders  great  services.  But  to  avail  ourselves  of  its  volatility  it 
must  be  given  free,  in  alcoholic  solution  diluted. 

Since  Storck,  hemlock  has  been  employed  empirically  for  gang- 
lionic  and  visceral  engorgements,  and  for  cancer.  The  moderns 
have  accorded  the  same  powers  to  the  alkaloid,  but  the  real  benefits 
are  limited  to  relief  from  the  pains  and  spasms.  In  scrofulous  oph- 
thalmia with  excessive  photophobia  and  palpebral  spasm,  Fron- 
mueller  and  Mauthner  applied  it  with  success.  In  inoperable  mam- 
mary cancer  with  axillary  involvement,  von  Schroff  reported  the 
cure  of  very  extensive  carcinomatous  ulcers  and  the  arrest  of  the 
malady  after  the  employment  of  conium  for  many  consecutive 
weeks1. 

Dujardin-Beaumetz  said  that  while  resembling  curare  it  differed 
in  also  sedating  the  pneumogastric,  and  caused  anesthesia.  He 
was  led  to  use  it  in  perturbations  of  this  nerve,  and  of  the  nervo- 
motor  system.  With  potassium  bromide  it  should  give  good  results 
in  convulsions,  especially  the  reflexes  emanating  from  the  vagus, 
convulsive  cough,  asthma,  whooping-cough,  hiccough,  dysphagia, 
vomiting,  spasmodic  bronchitis  and  laryngitis. 

Stewart  and  Corry  cured  with  cicutine  two  cases  of  traumatic 
tetanus. 

Welch  and  Harley  cured  choreics  with  it. 

In  the  convulsions  of  infancy,  in  tic  douloureux,  it  would  not  be 


148  CICUTINE 

bad.  As  it  accelerates  the  pulse  (Casaubon),  lessens  arterial  ten- 
sion (Pelvet),  perturbs  the  system  and  the  hematic  functions 
(Casaubon),  which  gives  the  key  to  its  resolving  action,  cicutinc 
should  exhibit  these  effects  when  pushed  to  sufficient  dosage. 

Huesemann  places  it  as  useful  for  muscular  spasms  of  peripheric 
origin,  angina  pectoris  (Erlenmeyer),  the  obstinate  and  fatiguing 
cough  of  phthisis  (Nega).  As  an  antidote  for  strychnine,  picro- 
toxin  and  carbolic  acid,  cicutine  has  not  succeeded.  It  is  not  as 
anodyne  as  morphine,  In  cardialgia  it  often  fails,  except  when  ac- 
companying functional  affections  of  the  liver  (Reil).  Locally  it  re- 
lieves the  pain  of  dental  caries. 

It  answers  marvellously  for  blepharospasm  and  photophobia ; 
and  Schultz  recommends  it  in  place  of  curarre  for  localized  spasms. 

Van  Praag  thinks  it  contraindicated  for  cachectics  and  those 
threatened  with  paralyses.  Reil  advises  to  avoid  large  doses  in 
neuralgias  in  chloroanemics,  and  finds  it  causes  vertigo  in  the  well 
nourished  and  plethoric,  and  those  of  irritable  temperament.  It  has 
failed  in  tetanus  and  hydrophobia. 

Cicutine  is  indicated  with  the  mydriatics  as  an  antispasmodic, 
for  hyperesthetic  and  neurosic  pains,  irritations  of  the  spinal  cord, 
painful  spasms  of  the  sphincters.  It  calms  the  lancinating  pains  of 
cancer  without  exercising  any  control  over  their  course.  In  spas- 
modic coughs  it  sedates  while  favoring  secretion.  It  procures  calm 
sleep,  without  heaviness  on  waking,  a  valuable  power.  As  an  anti- 
aphrodisiac  it  is  of  value,  combined  with  camphor  monobromide.  It 
also  controls  hysteria  at  the  height  of  the  paroxysm. 

In  cutaneous  hyperesthesias,  pruritus,  angina  pectoris,  it  has  had 
good  success.  In  tuberculous  meningitis  it  lowers  the  fever  and 
sedates  the  excited  brain.  In  all  maladies  of  infancy  with  hyperes- 
thesia  it  may  be  employed  with  success. 

The  best  preparation  is  the  hydrobromate,  the  dose  gr.  1-67,  to 
be  repeated  as  often  as  the  conditions  indicate,  every  ten  to  twenty 
minutes  in  acute  or  painful  affections,  or  three  granules  every  four 
hours  in  chronic  forms  of  disease. 

Subcutaneously  the  hydrobromate  may  be  given  in  watery  solu- 
tion in  doses  to  suit. 

Locally,  Van  Renterghem  recommends  a  solution  of  gr.  1-12  in 
!/4  to  3^4  drams  of  weak  alcohol,  for  application  to  the  skin  or 
mucosa  in  pain.  For  blepharospasm  and  scrofulous  glands  Mauth- 
ner  advises  gr.  1-12  in  i%  drams  of  sweet  almond  oil.  This  serves 
as  a  collyrium.  Or  we  can  use  a  solution  of  gr.  i*/2  in  150  minims 


CICUTINE  149 

of  weak  alcohol,  or  a  suspension  in  mucilage.  But  cocaine  has  re- 
placed cicutine  here. 

As  a  hypnotic  cicutine  may  replace  the  bulky  synthetics  so  ener- 
getically exploited  of  late.  There  is>  not  one  of  them  as  easily  given, 
or  so  certain  to  relieve  the  irritability  that  prevents  sleep;  while 
cicutine  has  an  anodyne  power  that  excels  all  of  them ;  and  while 
not  equal  to  that  of  morphine  it  can  be  used  in  many  cases  where 
the  latter  is  not  needed,  besides  being  free  from  the  physical  and 
moral  objections  accruing  to  the  use  of  all  opiate  derivatives.  When 
this  use  of  cicutine  is  fully  comprehended  it  will  become  one  of  the 
stand-bys  of  our  practice. 

In  cancer  a  few  doses  of  an  inert  or  uncertain  preparation  have 
been  given,  and  on  the  certain  failure  resulting  the  drug  has  been 
condemned  as  useless.  Give  it  internally  and  apply  it  locally  in  full 
doses,  and  see  what  the  ancient  repute  of  hemlock  is  worth  when 
administered  with  modern  thoroughness.  We  cannot  afford  to  lose 
anything  that  will  assuage  the  atrocious  pangs  of  cancer,  or  that  has 
a  possibility  of  a  cure.  The  hydrobromate  should  also  be  injected 
into  the  substance  of  the  tumor,  in  doses  beginning  with  gr.  2-67 
and  rising  to  full  toleration.  The  use  of  the  alkaloids  necessitates 
a  restudy  of  applied  therapeutics. 

As  a  sedative  to  the  motor  nerves  and  of  the  reflex  function  of 
the  spinal  cord,  cicutine  has  a  definite  indication.  Many  cases  show 
spinal  irritability  and  exaltation  of  the  reflex  excitability.  The  in- 
dication is  to  ascertain  and  remove  the  cause,  such  as  autotoxemia ; 
and  this  has  attracted  most  attention;  yet  the  power  of  cicutine  is 
not  to  be  despised.  Ganglionic  excess  calls  for  it,  from  whatever 
cause.  In  many  cases  of  mental  perturbation  cicutine  has  proved 
highly  useful.  Shaller  has  called  attention  to  its  value  when  the  pa- 
tient fears  the  coming  of  insanity,  or  actually  shows  evidences  of 
mental  aberration.  Also  in  the  nervous  disturbances  incident  to  the 
menopause,  it  has  proved  salutary.  In  fact,  the  whole  group  of  so- 
called  hysteric  affections,  is  speedily  controlled  by  cicutine.  These 
generally  show  a  state  of.  morbid  excitability,  an  exhaustion  of 
neural  force,  and  a  consequent  inability  to  withstand  the  numberless 
petty  irritations  of  life  without  an  explosion  of  temper  or  emotion. 
Here  cicutine  is  more  efficient  than  valerian,  and  pleasanter  to  ad- 
minister. The  two  are  synergistic,  and  may  often  be  combined  with 
advantage. 

In  true  asthma  cicutine  is  better  than  in  the  asthmatic  attacks 
incident  to  chronic  pulmonary  or  bronchial  maladies,  where  the 


150  CINCHONIDINE 

sedative  effects  of  the  drug  on  the  respiratory  apparatus  may  not  be 
advisable.  Stimulants  like  strychnine  or  aspidospermine  will  then 
do  better. 

Cicutine  has  not  been  given  sufficiently  in  motor  spasms  like 
chorea  and  epilepsy.  Alone  it  may  be  insufficient,  but  it  aids  other 
remedies  greatly,  and  should  form  part  of  the  treatment.  Muscular 
twitching  with  cerebral  fullness  sometimes  prevents  sleep,  and  here 
it  is  difficult  to  find  so  admirably  suitable  a  remedy  as  cicutine. 

Dysmenorrheas  of  the  spasmodic  variety,  and  when  connected 
with  pelvic  inflammations,  are  well  controlled  by  cicutine,  alone  or 
in  combination. 

The  fact  that  cicutine  partially  controls  the  effects  of  strychnine 
in  toxic  doses,  though  neither  prevents  the  fatal  result  from  the 
other,  well  illustrates  the  parallel  or  coincident  action  of  apparently 
antagonistic  agents. 

Now  that  a  uniform  and  effective  form  of  this  remedy  is  avail- 
able, we  may  expect  to  see  its  therapeutic  applications  multiplied  in 
the  near  future.  It  is  well  worth  further  study  and  trial. 


CINCHONIDINE. 

The  writer  once  undertook  to  demonstrate  the  chlorine  test  for 
quinine  before  his  class.  The  "quinine"  was  placed  in  a  test  tube, 
chlorine  water  and  ammonia  added,  and — no  green  color  ensued! 
As  long  as  quinine  costs  more  than  cinchonidine,  much  of  the  latter 
will  be  sold  as  true  quinine. 

Does  it  matter?  The  effects  of  cinchonidine,  physiologic  and 
therapeutic,  are  practically  identical.  The  dose  is  about  the  same. 
Some  stomachs  find  cinchonidine  easier  to  bear  than  quinine.  Pos- 
sibly when  the  alkaloids  that  thus  closely  resemble  each  other  are 
carefully  studied,  in  the  light  of  modern  science,  we  may  learn  why 
it  pleased  the  Creator  to  produce  several  of  these  bodies  instead  of 
one.  Minute  differences  will  be  discovered  rendering  each  more 
accurately  suited  to  certain  conditions  than  the  others.  But  this  has 
not  yet  been  done.  For  the  present  we  must  refer  the  reader  to  the 
chapter  on  quinine. 

Cinchonidine  is  very  slightly  soluble  in  water  or  in  ether,  more 
so  in  alcohol.  The  sulphate  is  soluble  in  100  parts  cold  and  4  parts 
boiling  water,  71  parts  alcohol,  easily  in  acidulated  water.  The 
hydrochlorate  is  soluble  in  about  40  parts  cold  water.  The  tannate 


THERAPEUTIC   NOTES 


THERAPEUTIC    NOTES 


CINCHONINE.     COCAINE  151 

is  a  white  tasteless  powder,  and  possibly  forms  the  basis  of  the 
"quinine"  chocolates  in  the  market.  It  has  been  recommended  in 
diarrheas  in  doses  of  five  to  fifteen  grains*  for  adults. 

CINCHONINE. 

The  value  of  cinchonine  lies  in  its  insolubility.  Requiring  over 
3,700  parts  of  water,  cold  or  hot,  to  dissolve  it,  this  salt  has  been  re- 
peatedly exploited  under  the  name  of  "tasteless  quinine."  It  is  only 
after  being  held  some  time  in  the  mouth  that  the  bitterness  is  de- 
veloped. For  children  it  may  be  given  mixed  with  powdered  sugar, 
and  chocolate  or  cinnamon,  without  difficulty.  This  slow  solution 
also  renders  cinchonine  less  apt  to  irritate  the  stomach.  There  is 
practically  no  available  solvent  for  cinchonine,  as  it  requires  371 
parts  of  ether,  or  400  of  chloroform.  The  best  solvent  is  a  mixture 
of  chloroform  and  alcohol.  Even  the  sulphate  requires  70  parts  of 
cold  water,  14  parts  of  boiling  water,  6  parts*  of  alcohol  or  60  of 
chloroform.  It  is  insoluble  in  ether,  but  readily  soluble  in  acidulated 
water. 

The  iodosulphate  of  cinchonine  is  known  as  Antiseptol.  It  is  a 
powder  used  instead  of  iodoform,  and  contains  50  per  cent  of  iodine. 

The 'therapeutic  uses  of  cinchonine  are  those  of  quinine. 

COCAINE. 

Standard  granules — Gr.  1-134,  1-67,  1-12;  gm.  .001,  .0005,  005. 

The  leaves  of  the  coca  plant  have  long  been  used  in  South  Amer- 
ica as  a  means  of  enabling  the  user  to  withstand  fatigue  and  the 
lack  of  food.  The  leaves  are  made  into  a  masticatory.  It  is  said  that 
incredible  journeys  are  made  by  the  Peruvian  Indians  while  chew- 
ing these  leaves.  When  the  Spaniards  conquered  Peru  they  found 
the  Incas  regarding  the  coca  plant  as  sacred,  and  immediately  pro- 
scribed it,  inflicting  the  death  penalty  on  any  native  on  whose 
premises  it  was  found  growing.  For  centuries  coca  attracted  no 
attention,  though  Isaac  Ott,  who  investigated  it  a  number  of  years 
ago  predicted  that  it  would  one  day  fill  a  great  place  in  therapeutics. 
But  it  was  not  till  Koller  discovered  the  anesthetic  action  of  cocaine 
that  the  medical  world  awoke  to  a  realization  of  the  value  of  this 
drug.  The  keen  commercial  instincts  of  the  nostrum  venders  aided 
in  the  exploitation  of  coca,  and  a  whole  noxious  brood  of  wines  and 
other  preparations  appeared.  Since  that  time  the  use  of  cocaine  as  a 


152  COCAINE 

habit  drug  has  become  so  extensive  that  some  states  have  been  com- 
pelled to  legislate  against  it,  and  to  regulate  its  sale  more  closely 
than  the  deadliest  poisons. 

In  fact,  when  one  realizes  the  harm  done  by  this  agent  it  seems 
as  if  there  were  wisdom  in  the  Spanish  regulations.  In  Peru  in- 
veterate consumers  of  coca  are  known  as  coqueros,  and  are  recog- 
nizable by  their  unsteady  gait,  lax  yellowish  gray  skin,  lack-luster 
eyes  surrounded  with  brown  rings,  tremulous  lips,  incoherent  speech, 
stupid  and  apathetic  condition.  They  are  suspicious,  hesitating, 
false  and  cunning.  The  signs  of  old  age  appear  before  midlife,  and 
if  they  survive,  imbecility  results. 

Physiologic  and  Toxic  Actions. — Prolonged  use  of  moderate 
doses  of  coca  causes  diminished  salivary  secretion,  and  sensation  in 
the  mouth,  oesophagus  and  stomach ;  weakness  in  the  legs,  dilated 
pupils,  irregular  pulse  and  respiration,  higher  temperature,  a  dreamy 
state  of  the  mind,  disturbed  sleep,  aphonia,  unsteady  gait,  pleasant  or 
frightful  hallucinations,  and  delirium.  These  are  especially  evident 
after  a  coca  debauch.  Exhaustion  and  depression  do  not  follow 
such  a  spree. 

The  whole  central  nervous  system  is  affected  by  cocaine,  which 
acts  directly  on  the  nerve  cells  without  affecting  the  circulation.  The 
increase  of  reflex  excitability,  the  superactivity  of  the  circ'ulatory 
and  muscular  systems,  are  evidences  of  the  excitation  of  the  centers 
at  the  base  of  the  brain.  Generally  the  stimulation  of  cocaine  is  fol- 
lowed" like  that  of  caffeine  by  a  return  complete  and  without  tran- 
sitional states  to  the  normal  state.  Enormous  doses  cause  an  inter- 
vening stage  of  weakness  and  paralysis.  Toxic  doses  are  required 
by  the  mouth  to  dilate  the  pupils  though  small  ones  applied  locally 
accomplish  this  readily. 

*  Von  Schroff  says  that  after  an  initial  acceleration  of  the  respira- 
tion there  is  slowing.  The  pulse  is  hastened  by  medium  doses,  re- 
tarded by  maximal  doses.  The  cardiac  fibers  of  the  pneumogastric 
lose  their  excitability  after  small  doses  and  are  paralyzed  by  medium 
doses.  The  rapid  pulse  is  therefore  as  with  atropine  due  to  paralysis 
of  the  inhibitory  nerve.  Medium  doses  increase  vascular  tension, 
large  doses  lessen  it  rapidly.  The  surface  heat  is  augmented,  while 
the  central  heat  falls  half  to  one  degree  Cent.  From  the  moment  the 
subject  enters  the  convulsive  stage  the  anal  temperature  rises  above 
normal. 

Rossbach  says  the  striated  muscles  are  unaffected.  Intestinal 
peristalsis  after  a  momentary  increase  with  ischemia  of  the  intestinal 


COCAINE  163 

walls  is  quickly  followed  by  a  notable  diminution  of  motion,  dilata- 
tion and  venous  congestion.  Mucous  secretion  and  saliva  are  les- 
sened. 

No  constant  effect  on  the  renal  functions  has  been  determined. 

In  fatal  poisoning,  death  is  due  to  respiratory  paralysis.  The 
heart  continues  to  beat  after  death  for  some  time. 

Von  Anrep  made  some  experiments  to  determine  how  far  coca 
replaced  food,  and  found  that  death  by  starvation  occurred  as 
quickly  when  coca  was  taken  as  without  it.  The  runners  who  go 
long  distances  without  food  under  its  influence  make  up  for  it  by 
gorging  afterwards.  But  the  weight  of  opinion  favors  the  view  that 
cocaine  aids  nutritional  movements. 

Espinosa  saw  under  the  influence  of  coca  a  notable  increase  in 
the  excretion  of  urea  and  uric  acid,  as  well  as  of  phosphoric  acid, 
and  an  increased  exhalation  by  the  lungs  of  carbonic  acid.  Of  two 
rats  starved  by  Moreno  y  Mais,  the  one  that  was  given  coca  died  in 
five  days,  having  lost  one-half  more  weight  than  the  other  which 
took  no  coca,  and  this  rat  survived.  Demarle  also  concluded  that 
emaciation  was  not  prevented  by  coca,  which  therefore  cannot  be  as- 
similated with  caffeine  and  arsenic.  These  moderate  the  nutritional 
movement  while  cocaine  accelerates  it. 

As  with  most  plant  remedies,  cocaine  does  not  exactly  represent 
the  effects  of  coca,  and  it  is  evident  that  there  are  other  active  agents 
in  the  leaves,  in  variable  amounts  and  proportions.  The  yield  of 
cocaine  varies  from  0.8  per  cent  down  to  0.2  per  cent ;  the  other  alka- 
loids being  more  plentiful  when  the  cocaine  is  less.  The  extraction 
is  difficult.  Cocaine  is  made  synthetically,  the  product  being  identical 
therapeutically  with  that  from  the  leaves. 

Liebreich  says  that  cocaine  acts  on  all  the  nervous  centers  be- 
ginning with  the  cerebrum  and  ending  with  spinal  cord.  The  stimu- 
lant effect  is  far  more  prominent  from  small  doses.  It  is  not  a 
nerve  poison  but  only  "surfeits  the  cells  with  food."  The  greater 
the  brain  and  the  higher  the  temperature,  the  smaller  the  dose  that 
will  cause  convulsions.  It  increases  the  quantity  of  air  in  the  lungs 
by  first  increasing  and  then  decreasing  the  rate  of  breathing.  This 
indicates  that  in  fever  there  may  be  seen  more  effect  from  cocaine 
than  in  health. 

Small  doses  do  not  affect  the  lumen  of  the  blood-vessels ;  medium 
doses  cause  strong  contraction,  and  large  doses  dilation  from  ac- 
tivity of  the  vasomotors.  Applied  to  mucous  membranes,  cocaine 
solutions  cause  contraction  of  the  blood-vessels  with  cylindrical 


154  COCAINE 

epithelium  sooner  than  with  the  tesselated  variety;  and  sooner  with 
children  than  with  adults.  The  cerebral  vessels  are  rarely  altered. 
The  heart-action  is  uninfluenced  by  small  doses,  accelerated  and  even 
strengthened  by  medium  doses  and  slowed  by  large  ones.  Cocaine 
cannot  completely  stop  the  heart. 

There  is  a  rise  also  in  the  venous  pressure  after  medium  doses 
of  cocaine,  and  a  fall  after  large  ones.  Small  doses  increase  the 
working  power  of  the  muscles1,  more  in  those  that  have  been  at  rest 
than  in  those  that  are  already  fatigued.  When  cocaine  is  taken  dur- 
ing long  marches  the  muscles  recuperate  very  quickly  on  rest.  But 
intermuscular  injections  diminish  the  force. 

When  administered  by  the  stomach  cocaine  can  manifest  its  ef- 
fects in  20  minutes;  by  the  subcutaneous  method  in  10  minutes.  It 
appears1  first  in  the  urine.  It  is  eliminated  by  the  mucous  membranes 
also.  When  convulsions  and  dyspnea  appear  albumin  and  sugar 
may  be  found  in  the  urine.  The  urine  is  increased  (we  are  quoting 
Liebreich),  but  mucous  secretions  lessened. 

The  use  of  cocaine  as  a  local  anesthetic  dates  from  Roller's  pub- 
lication in  1884.  The  remedy  must  come  in  contact  with  the  tissue 
to  be  anesthetized,  when  all  varieties  of  sensation  are  dulled.  Or  it 
may  be  applied  to  the  trunk  of  a  nerve.  On  the  unabraded  skin  it 
has  no  influence  unless  driven  in  by  cataphoresis.  The  motor  nerves 
are  affected  as  well  as  those  of  general  and  special  sense.  The  tip 
of  the  tongue  cannot  be  anesthetized  by  the  strongest  solutions.  Ap- 
plied to  the  eye  it  contracts  the  vessels,  causing  a  slight  sense  of 
burning,  followed  by  dryness,  coldness  and  pallor.  The  lids  open 
wider,  the  pupils  dilate,  there  is  anesthesia  and  -analgesia  of  the 
cornea  and  conjunctiva,  but  not  of  the  iris. 

These  phenomena  appear  in  one  to  three  minutes  and  last  five 
to  fifteen.  Intraocular  pressure  is  first  slightly  increased  and  then 
lessened.  Accommodation  is  slightly  limited,  but  never  paralyzed. 
Exophthalmia  may  be  simulated.  Mydriasis  comes  in  ten  to  twenty 
minutes  and  lasts  some  hours,  or  a  day.  The  dilation  can  always  be 
increased  by  atropine.  Solutions  of  one  to  two  per  cent  are  strong 
enough  for  the  eye. 

Cushny  attributes  the  rapid  pulse  to  stimulation  of  the  accelerator 
mechanism  rather  than  to  sedation  of  the  inhibitory  apparatus.  If 
so,  cocaine  is  not  a  direct  antagonist  of  aconitine.  Constriction  is 
due  to  direct  stimulation  of  the  vasoconstrictor  centers  for  section  of 
the  splanchnics  relaxes  the  vascular  tension.  Total  anuria  for  hours 
sometimes  follows  the  use  of  cocaine,  so  that  it  seems  likely  that  the 


COCAINE  155 

effect  on  the  kidneys  is  due  to  the  action  on  the  bloodvessels.  Cocaine 
may  be  termed  a  general  protoplasmic  poison. 

Van  Renterghem  thus  describes  the  results  of  hi&  experiments  in 
testing  cocaine  on  his  own  person :  Between  noon  and  4  p.  m.  he 
took  ten  doses  of  Merck's  pure  cocaine,  each  of  ten  centigrams, 
about  1.5  grains.  The  drug  was  allowed  to  dissolve  in  the  mouth 
that  the  local  effect  could  be  studied  at  the  same  time.  During  the 
four  hours  he  thu&  took  870  milligrams  of  cocaine,  or  about  14 
grains.  After  the  second  half-hourly  dose  he  felt  no  longer  the 
slight  tendency  to  sleep  which  had  ensued  after  a  bad  night.  After 
the  third  dose  an  agreeable  sensation,  like  that  of  slight  alcoholism. 
Cerebral  activity  ensued,  he  worked  with  pleasure,  thoughts  followed 
each  other  quickly,  the  judgment  was  more  prompt.  The  humor 
was  gay ;  he  felt  benevolence  for  all  the  world.  This  state  was  main- 
tained throughout  the  experiment.  After  the  seventh  dose  he  per- 
ceived an  agreeable  warmth,  the  face  was  red,  the  pulse  accelerated, 
the  respiration  normal.  He  felt  the  desire  to  talk,  without  cessation, 
and  to  be  in  movement.  He  felt  the  capacity  to  lift  great  weights. 
These  symptoms  lasted  three  hours  after  the  last  dose,  then  slowly 
subsided,  so  that  by  1 1  p.  m.  everything  had  returned  to  the  normal 
state.  At  noon  the  pulse  was  74,  temp.  37.4  C.  in  the  armpit ;  when 
the  last  dose  was  taken,  pulse  no  to  120,  temp.  37.4  in  the  anus,  37.9 
under  the  arm;  at  n,  when  retiring,  temp,  under  the  arm  37.4,  pulse 
76.  During  the  evening,  which  was  passed  at  the  theater,  he  felt 
no  exhaustion,  no  fatigue.  Dining  at  4 130  he  felt  no  hunger  but  ate 
mechanically  as  was  his  custom.  The  loss  of  taste  may  have  ex- 
plained this.  He  would  have  been  as  well  satisfied  to  miss  the  meal. 
Digestion  was  good.  No  effect  on  the  stools  or  the  urine.  Retired 
at  1 1 130,  after  a  light  repast,  and  passed  a  good  night.  At  the 
moment  of  retiring  he  felt  head  a  little  contracted,  slight  indication 
of  aching  in  the  forehead,  above  the  eyes,  and  at  the  vertex.  Next 
morning  this  lasted  till  noon. 

Experimenting  upon  himself  Von  Schroff  found  small  doses  in- 
creased the  activity  of  the  brain,  while  large  ones,  after  a  brief  period 
of  excitation,  depressed  the  activity  of  the  brain  and  caused  som- 
nolence. Fronmueller  observed  vertigo,  delirium,  ringing  of  the 
ears,  and  slumber.  Plass  fe*lt  vertigo  and  a  sense  of  feebleness. 

The  vast  majority  of  persons  addicted  to  the  cocaine  habit  ac- 
quire that  accomplishment  through  the  use  of  nostrums  containing 
that  drug,  especially  when  used  for  hay  fever  and  catarrh.  Many 
morphine  habitues  add  the  use  of  cocaine  which  enables  them  to  use 


156  COCAINE 

more  morphine  and  prolong  the  waking  period,  that  of  euphoria. 
Physicians*  in  busy  practice  also  acquire  the  habit  to  enable  them  to 
work  beyond  their  natural  strength.  In  the  South  it  is  said  that 
the  negroes  are  becoming  addicted  to  this  dangerous  drug;  and  it 
seems  possible  that  the  frightful  crimes  for  which  lynching  is  ap- 
plied are  due  to  cocaine. 

The  cocainist  uses  the  drug  almost  constantly,  injecting  or  snuf- 
fing a  few  drops  of  solution  every  few  minutes.  He  is  restless,  con- 
stantly on  the  move,  facile,  an  easy  talker,  good  companion,  tells 
good  stories  but  tends  to  ramble  on  disconnectedly.  He  sits  up  all 
hours  of  the  night,  writing  endlessly,  the  product  of  the  night's 
labor  being  found  scattered  over  the  floor  in  the  morning.  Ask  why 
he  uses  cocaine  and  he  cannot  tell.  The  most  remarkable  symptom 
is  the  utter  lack  of  the  moral  principle.  Obligations  sacred  to  even 
the  most  abandoned  have  no  importance  to  him.  He  is  cunning, 
devises  most  plausible  schemes  to  obtain  cocaine.  Once  succeeding, 
he  makes  no  effort  to  keep  up  the  deception,  regarding  it  as  a  joke, 
and  depending  on  his  wits  to  devise  another  scheme  when  a  new 
supply  is  needed.  Later  he  suffers  with  hallucinations,  gets  to  pick- 
ing "cocaine  bugs"  from  his  skin,  thinks  he  is  pursued  by  mobs  for 
wholesale  murders  he  has  committed,  etc.  He  rarely  stops  with 
cocaine  but  seeks  to  add  all  other  habit-drugs  of  which  he  learns  the 
use.  Thus  one  man  used  morphine,  cocaine,  absinthe,  whisky,  men- 
thol, chloroform,  cannabis  Indica,  and  hyoscine. 

After  a  pretty  large  experience  with  various  drug  habits,  the 
writer  is  skeptical  as  to  the  curability  of  the  cocaine  habit  when  once 
fully  formed.  Nothing  is  needed  except  deprivation  of  the  drug, 
no  special  suffering  ensues  from  its  discontinuance.  But  the  patient 
is  utterly  untrustworthy,  and  will  secure  the  drug  unless  confined 
as  in  an  insane  asylum.  Such  restraint  for  a  year  is  the  only  means 
of  cure;  and  in  one  such  case,  after  years'  freedom  the  man  went 
deliberately  back  to  the  drug  and  killed  himself  with  it.  Another, 
after  six  months  in  an  asylum  held  himself  straight  for  nearly  two 
years,  and  one  day  killed  himself  with  an  overdose.  One  man  after 
a  year's  abstinence,  has  remained  free  for  five  years  and  is  to  all  in- 
dications cured,  but  whether  this  will  prove  permanent  remains  to 
be  seen.  It  is  almost  the  only  exception  in  the  writer's  knowledge. 
And  this  Applies  to  persons  treated  by  every  real  expert  and  secret 
nostrum  dispenser  in  the  country.  One  man  has  been  to  17  sanitaria 
for  drug  habits,  and  is  now  practically  a  life  inmate.  The  difficulty 
is  in  the  absence  of  the  moral  sense,  and  consequently  of  any  real 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


COCAINE  167 

desire  on  the  part  of  the  habitue  to  be  cured.  In  this  there  is  a 
radical  difference  from  the  morphine  victim,  who  in  even  the  last 
stages  revolts  against  his  slavery  and  dies'  purposely  if  he  cannot 
break  his  chains.  The  writer  has  never  seen  evidence  of  a  restora- 
tion of  the  moral  sense  after  it  has  once  been  extinguished  by 
cocaine. 

Another  characteristic  of  the  cocainist  which  should  have  been 
mentioned  is  his>  insensibility  to  pain  on  the  one  hand  and  his  exag- 
gerated way  of  talking  about  it  on  the  other.  He  will  use  the 
dirtiest  ditch  water  for  his  solutions,  half  fill  his  syringe  with  the 
dirty  mixture  and  inject  dirt,  air  and  all  into  a  vein  to  get  quick 
effect  with  the  most  absolute  indifference  to  results.  In  fact,  the 
writer  has  known  men  to  do  this  to  demonstrate  the  harmlessness  of 
air  in  the  veins.  If  abscess  or  ulcer  results,  so  much  the  better,  for 
this  gives  him  an  excuse  for  obtaining  more  cocaine!  But  inflict  on 
him  the  most  trifling  suffering — even  the  prick  of  the  hypodermic 
he  has  used  hundreds  of  times,  and  he  will  complain  for  weeks  of 
the  "sufferings  of  the  damned"  caused  by  it. 

Synergists. — Caffeine  like  cocaine  excites  the  cerebral  cells  and 
the  muscular  system.  Strychnine  increases  the  excitability  of  the 
spinal  cord.  Cicutine  and  brucine,  as  well  as  yohimbine,  cause  local 
anesthesia  and  analgesia.  Atropine  paralyses  the  cardiac  inhibitory 
nerves,  and  dilates  the  pupil.  Aconitine  also  dilates  the  pupil,  but 
in  its  general  action  is  antagonized  by  cocaine  even  more  exactly 
than  by  atropine. 

Incompatibles. — Hydrochloric  acid  breaks  cocaine  up  into  ecgo- 
nine,  alcohol  and  benzoic  acid. 

Therapeutics. — The  local  applications  of  cocaine  are  too  well 
known  to  require  enumeration.  Solutions  may  be  applied  to  the 
unbroken  mucous  membranes  but  the  cutaneous  epithelium  bars  its 
action.  It  is  used  subcutaneously  along  the  lines  of  an  operation,  or 
injected  at  some  part  so  as  to  come  in  contact  with  the  trunk  of  the 
nerve  at  whose  distribution  anesthesia  is  desired.  Injected  into  the 
spinal  canal  anesthesia  of  the  entire  lower  extremity  including  the 
pelvic  organs  is  secured.  This  has  been  utilized  to  secure  painless 
parturition.  One  nice  local  application  is  in  the  removal  of  foreign 
bodies  imbedded  in  the  cornea.  The  cocaine  not  only  anesthetizes 
the  cornea  but  the  contraction  of  the  vessels  often  releases  the 
foreign  body  and  facilitates  its  removal.  Cocaine  is  also  applied 
locally  to  reduce  reflex  action  and  to  relieve  pain,  such  as  neuralgia, 
where  the  salt  is  injected  along  the  course  of  the  affected  nerve. 


158  COCAINE 

The  hydrochlorate  of  cocaine  is  the  salt  used,  and  it  is*  soluble 
in  almost  any  proportion  in  water,  alcohol,  alkaline  solutions, 
glycerin,  oleic  acid,  etc.  Solutions  lose  their  value  soon,  and  should 
be  prepared  freshly  when  needed. 

Internally  cocaine  has  been  recommended  as  a  means  of  tiding 
the  morphine  habitue  over  the  withdrawal  period.  The  writer  has 
seen  many  such  cases,  and  the  invariable  result  of  this  medication 
has  been  that  the  suffering  is  simply  postponed  and  recurs  when  the 
patient  is  less  able  to  bear  it ;  while  the  patient  is  too  apt  to  add  the 
cocaine  habit  to  his  preexisting  ones. 

Wood  recommends  cocaine  as  a  cardiac  stimulant  in  pneumonia, 
alternating  with  strychnine,  and  claims  that  the  effects  of  the  latter 
are  thus  supplemented.  But  this  author  has  apparently  not  tried  the 
use  of  strychnine  by  cumulative  dosage.  There  is  nothing  in  the 
studies  here  recorded  of  the  physiologic  action  of  cocaine  to  indicate 
its  use  in  this  manner.  Indeed,  the  well-known  variability  of  this 
drug  as  to  its  effects  on  individuals  renders  it  improper  for  use  with 
those  on  whom  it  has  not  been  tried.  For  while  large  doses  may 
be  well  borne  by  one  man,  another  may  be  injuriously  affected  by 
even  half  a  milligram — gr.  1-134. 

Special  care  must  be  taken  in  administering  cocaine  to  alcoholics, 
who  are  apt  to  react  unfavorably  to  it.  But  in  threatened  mania-a- 
potu  a  combination  of  cocaine  with  capsicin  has  proved  the  most 
effective  treatment  the  writer  has  ever  employed.  Here  gr.  1-12  to 
1-18  of  cocaine  with  the  same  dose  of  capsicin  may  be  given  every 
one  to  two  hours.  This  has  dissipated  an  impending  delirium 
tremens  that  seemed  unavoidable. 

The  untoward  effects  described  are  attributed  by  Liebreich.  to 
other  active  principles  in  the  coca  not  separated  from  the  cocaine  in 
the  process  of  extraction.  The  use  of  synthetic  cocaine  or  of 
eucaine  is  not  liable  to  this  uncertainty.  The  writer  has  witnessed 
alarming  heart  failure,  syncope,  etc.,  continuing  and  recurring  for 
hours,  after  cocaine  used  locally  or  internally.  A  sense  of  debility, 
malaise  and  anxiety  are  common.  There  may  be  excess  or  failure 
of  any  of  the  secretions  or  functions  of  the  body.  These  symptoms 
may  end  in  collapse. 

The  treatment  of  cocaine  poisoning  consists  in  the  evacuation  of 
the  stomach  if  taken  by  that- route,  and  the  administration  of  stimu- 
lant doses  of  morphine — gr.  y% — of  ammonia,  glonoin  for  syncope, 
and  brucine  to  sustain  quickly  the  heart  and  respiration. 

Van  Renterghem   recommends  cocaine  internally   for  vomiting 


COCAINE  169 

due  to  gastric  hyperesthesia  and  excited  by  the  contact  of  food ;  and 
in  gastralgia  of  ulcer. 

Rabuteau  recommended  cocaine  in  diabetes  mellitus  and  in  al- 
buminuria,  believing  that  its  action  enhances  the  combustion  of  sac- 
charine and  albuminoid  matters,  which  are  thus  utilized  instead  of 
being  eliminated  as  a  loss.  He  also  advised  it  for  phthisis,  to  in- 
crease the  digestive  powers.  Under  its  influence  he  saw  the  ap- 
petite increase  and  the  vomiting  cease,  even  with  subjects  in  the  third 
stage.  But  as  cocaine  increases  waste,  the  arsenates,  or  caffeine, 
with  the  hypophosphites,  should  be  also  administered  to  retard  the 
movement  of  assimilation  and  disassimilation. 

The  action  of  cocaine  is  increased  by  adding  strychnine  and  caf- 
feine when  given  to  enable  one  to  bear  unavoidable  fatigue  or  pro- 
longed exertions  and  exposure.  But  that  this  is  a  ready  mode  of  es- 
tablishing the  cocaine  habit  scarcely  needs  to  be  said. 

Manassein  found  cocaine  effective  in  relieving  the  vomiting  and 
collapse  of  cholera  morbus.  Shoemaker  says  it  sometimes  relieves 
migraine  promptly.  For  vomiting  of  pregnancy  and  for  seasickness 
it  is  often  useful.  The  dysphagia  of  laryngeal  tuberculosis  may  be 
relieved  by  cocainizing  the  affected  parts  before  meals.  Thorington 
found  it  useful  in  yellow  fever. 

Bartholow  praised  it  in  hiccough,  asthma,  chorea,  paralysis 
agitans,  senile  tremor,  and  that  of  alcoholism.  An  Algerian  physi- 
cian reported  that  cocaine  was  markedly  tolerated  in  smallpox  and 
beneficial.  Bauduy  advised  it  in  melancholia  but  others  deny  this. 

Taken  altogether,  considering  the  remarkable  properties  of  this 
alkaloid,  surprisingly  little  is  to  be  said  as  to  its  internal  therapeutics. 
This  is  largely  due  to  the  danger  of  the  habit,  which  renders  it  even 
more  perilous  than  morphine,  as  the  formation  of  the  habit  of 
cocaine  is  so  much  more  insidious.  There  are  thousands  of  cocain- 
ists  who  have  not  yet  found  it  out.  The  writer  has  tried  the  use  of 
coca  in  training  boat  crews  for  races  and  found  the  same  crew  did 
better  without  it.  Whatever  it  does  when  the  fresh  leaves  are 
chewed  in  Peru,  no  such  effects  as  are  described  are  obtainable  from 
cocaine  or  from  any  of  the  preparations,  officinal  or  proprietary,  to 
be  found  in  the  shops.  Possibly,  as  Rusby  suggests,  there  is  a 
volatile  element  in  the  fresh  leaves  that  is  lost  in  drying  them. 

The  dose  of  cocaine  internally  for  any  sort  of  vomiting  is  gr. 
1-67  every  fifteen  minutes  till  effect.  As  a  cardiac  stimulant  in 
pneumonia  gr.  1-6  may  be  given  every  eight  hours  with  a  dose  of 


160  CODEINE 

strychnine  alternated.    Many  of  the  effects  attributed  to  coca,  thera- 
peutic as  well  as  toxic,  are  undoubtedly  suggestive. 

Since  brucine  is  a  local  anesthetic  and  a  heart  tonic  as  well,  the 
writer  has  employed  a  five  per  cent  solution  of  the  hydrochlorate 
with  cocaine  added  in  two  per  cent,  in  those  cases  where  the  use  of 
cocaine  alone  was  followed  by  symptoms  of  syncope  or  collapse. 
This  has  proved  successful  in  every  case  as  yet  tested  with  it. 

CODEINE. 

Standard  granules — Gr.  1-67;  gm.  .001;  gr.  1-6,  gm.  .01. 

In  1832  codeine  was  discovered  by  Rebiquet.  Chemically  it  is 
a  methyl  morphine.  It  is  soluble  in  alcohol,  ether,  chloroform, 
benzole,  petrolether,  amylic  alcohol  and  diluted  acids,  fairly  soluble 
in  water  and  slightly  in  ammonia.  It  is  a  strong  base,  and  a  number 
of  salts  are  listed.  The  phosphate  is  especially  soluble  in  water. 
Van  Renterghem  takes  occasion  to  say:  "Chemistry  which  has 
isolated  the  different  principles  of  opium,  and  experimental  physi- 
ology, have  taught  us  their  modes  of  action;  so  that  it  is*  quite  na-x 
tural  for  the  clinician  to  reject  this  dangerous  composition,  this 
double-edged  tool  as  Hufeland  termed  it,  and  use  only  the  principal 
extractives,  of  which  one  can  always  measure  the  action." 

Binz  says :  "In  prescribing  opium,  the  physician  gives  to  the 
patient  a  complex  substance  which  can  produce  inconvenient  and 
uncontrollable  effects  since  they  depend  on  the  richness  of  the  med- 
icament, always  variable,  in  diverse  active  principles.  In  grave 
cases  where  he  desires  the  narcotic  action — that  of  morphine — he 
should  avoid  prescribing  opium." 

Water  at  60  F.,  dissolves  pure  codeine  12.6  parts  in  1,000;  at 
212  F.  58.8  parts.  Crude  opium  yields  about  0.6  per  cent  of  codeine. 
Codeine  has  been  prepared  synthetically  by  heating  an  alcoholic 
solution  of  morphine  with  soda  and  methyl  iodide. 

Physiologic  Action. — Van  Renterghem  one  evening  took  100 
milligrams  of  codeine  in  divided  doses.  There  resulted  slight  red- 
ness of  the  face,  slight  excitement  of  the  nervous  system,  but  sleep 
did  not  supervene  till  late.  The  sleep  was  light,  troubled  by 
dreams ;  on  waking,  pressure  at  the  temples,  disagreeable  sensation 
in  the  head,  and  absence  of  appetite.  Though  the  usual  dose  of 
saline  was  not  taken  there  were  liquid  stools.  At  i  p.  m.  next  day, 
after  a  good  walk  in  the  open  air,  all  signs  of  the  intoxication  had 
vanished. 

The  same  observer  has  often  taken  at  bedtime  a  single  dose  of 


CODEINE  161 

codeine,  10  milligrams,  with  sleep  following  shortly.  This  was  pro- 
found, the  waking  without  discomfort  but  a  sense  of  well  being  and 
restfulness. 

Rabuteau  found  doses  of  150  milligrams  produce  in  half  an  hour 
muscular  fatigue,  itching,  worse  in  extremities,  pupillary  contrac- 
tion, lasting  more  than  a  day;  no  sleep,  scarcely  the  beginning  of 
somnolence. 

Bardet  found  no  effect  from  doses  under  three  grains,  which 
caused  heaviness  of  the  head,  muscular  weakness,  but  no  hypnosis. 
Six  grains  caused  such  weakness  that  walking  was  impossible ;  with 
pruritus  often  and  twice  erythema. 

Huesemann  found  codeine  in  small  doses  hypnotic,  but  in  large 
doses  the  effect  approximated  that  of  picrotoxin. 

Van  Renterghem  resumes  the  evidence  and  concludes  that 
codeine  in  small  doses  has  an  action  calmant,  lightly  hypnotic,  quiet- 
ing the  sense  of  hunger,  neither  constipating  nor  deranging  diges- 
tion ;  in  large  doses  it  excites,  causes  agitation,  headache,  inap- 
petence,  nausea,  vomiting  and  may  lead  to  convulsions.  Experi- 
ments on  animals  seem  to  show  a  more  pronounced  convulsant  ac- 
tion than  that  of  morphine.  Liebreich  found  from  codeine  an  in- 
crease of  reflex  excitability  of  the  spinal  cord,  going  with  increased 
doses  to  tetanic  convulsions,  and  death  from  asphyxia  and  general 
paralysis  finally.  He  notes  from  large  doses  also  a  sense  of  heat, 
trembling  of  the  muscles  and  slow  pulse. 

Cushny  says  codeine  depresses  the  brain  less  than  morphine  and 
stimulates  the  cord  and  medulla  more.  The  respiration  is  not  so 
much  slowed  and  may  even  be  accelerated. 

Tauber  says  codeine  is  mainly  excreted  by  the  kidneys. 

Murrell  says  that  codeine  is  merely  a  little  morphine,  acting 
similarly  in  larger  doses ;  but  this  is  not  borne  out  by  the  foregoing 
account. 

Therapeutics. — As  a  hypnotic  and  antispasmodic  codeine  does  not 
replace  morphine,  but  may  be  used  where  it  does  not  agree.  Cushny 
also  prefers  codeine  for  the  insomnia  of  melancholia.  When 
there  is  any  tendency  to  cerebral  hyperemia  codeine  is  preferable  to 
morphine.  While  either  will  induce  a  drug  habit  codeine  is  some- 
what less  liable  to  do  so. 

Brunton  and  Freund  claim  that  codeine  has  a  specific  effect  in 
relieving  pains  of  the  intestines  and  ovaries.  It  has  also  been  ad- 
vocated for  blepharospasm,  photophobia,  sciatica,  gastralgia,  bulimia, 
hepatic  and  ovarian  colics. 


162  CODEINE 

But  it  is  in  affections  of  the  respiratory  apparatus  that  codeine 
finds  its  chief  use.  It  soothes  the  disposition  to  cough  and  promotes' 
freer  expectoration.  Van  Renterghem  combines  codeine  with  iodo- 
form,  to  calm  coughs,  and  soothe  pain  in  the  alimentary  canal.  In 
dry  coughs  he  gives  codeine  with  apomorphine,  especially  in  late 
phthisis.  With  cicutine  or  helenine  it  is  serviceable  in  spasmodic 
coughs.  Given  with  veratrine  it  prevents  irritation  of  the  stomach 
in  those  who  cannot  take  the  latter  alone.  In  gastralgia,  enteralgia 
and  pains  about  the  neck  of  the  bladder,  codeine  acts  as  an  anodyne 
without  interfering  with  the  digestion  or  constipating.  Here  he 
associates  hyoscyamine,  atropine,  cicutine  and  the  vital  incitant, 
strychnine.  In  infantile  practice  codeine  replaces  morphine  gen- 
erally as  an  anodyne  and  hypnotic;  also  in  women,  aged  persons 
and  those  menaced  with  congestions  of  the  brain  (Gubler). 

Trousseau  also  recommended  codeine  in  acute  bronchitis  with 
hyperesthesia  and  spasm  of  the  bronchi,  and  constant  cough. 

Vigla  and  Aran  recommended  codeine  in  bronchorrhea  and  in- 
testinal relaxation,  to  lessen  mucous  hypersecretion. 

Codeine  has  been  extensively  employed  in  the  treatment  of 
diabetes  mellitus  and  insipidus.  It  lessens  the  excretion  of  urine 
and  the  output  of  sugar.  The  doses  here  have  been  raised  to  15 
grains  a  day,  there  being  a  special  tolerance  of  the  drug.  It  is 
doubtful  if  codeine  possesses  any  special  advantage  here  over  mor- 
phine except  for  the  absence  of  ill  effects  in  the  alimentary  canal. 
Shoemaker  says  some  cases  are  cured  and  many  benefited  by  codeine. 
Van  Renterghem  speaks  well  of  this  agent  in  strangury,  in  chronic 
urinary  affections.  He  recommends  here  codeine  with  atropine  and 
cicutine. 

Lochbuehler  thinks  codeine  has  a  special  control  over  serous  in- 
flammations. Brunton  credits  it  with  a  specific  influence  over  the 
sympathetic,  and  recommends  it  for  the  severe  pains  of  perityphlitis, 
abdominal  tumor,  fecal  impaction,  cancer  of  the  liver  and  pancreas, 
and  appendicitis. 

Domblueth  preferred  codeine  to  hyoscine  in  sedating  the  insane, 
when  the  latter  caused  hallucinations,  and  if  there  were  anxiety, 
precordial  distress  or  insomnia. 

Merck's  codeine  is  about  half  the  strength  of  morphine.  The 
dose  for  an  adult,  single,  at  bedtime  is  gr.  1-6;  for  an  infant  from 
1-134  to  1-67.  Either  may  be  repeated  every  half-hour  if  needed. 
The  same  care  should  be  exercised  as  in  administering  morphine. 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


COLCHICINE  163 

0 

COLCHICINE. 

Standard  granule — Gr.  1-134,  grn.  .0005. 

Colchicine  is  the  active  principle  of  Colchicum  autumnale, 
meadow  saffron,'  and  is  found  also  in  other  species  of  colchicum. 
It  is  doubtful  if  colchicine  ranks  with,  the  alkaloids,  as  a  pyridine  de- 
rivative, since  it  has  an  acid  reaction.  It  is  soluble  in  water,  alcohol, 
ether  and  chloroform. 

This  drug  has  fallen  into  disuse  from  the  uncertainty  of  its  prep- 
arations. There  are  two  wines,  two  tinctures  and  two  fluid  extracts, 
of  the  root  and  seed,  each  with  a  different  dose.  And  yet  nearly 
every  writer  on  this  drug  selects  one  preparation,  condemning  the 
rest  as  worthless ;  and  that  selected  is  usually  not  officinal  but  a  pro- 
prietary .article,  such  as  Allen's  wine  of  the  root.  The  writer  has 
always  been  bewildered  when  he  tried  to  prescribe  colchicum  and 
generally  resorted  to  his  books  before  doing  so ;  and  even  then,  he 
has  never  prescribed  a  galenic  of  colchicum  with  any  certainty  as  to 
the  effect  to  be  expected.  As  the  effect  of  any  of  these  is  simply 
due  to  the  active  principle  contained,  it  is  obvious  that  colchicum  i» 
preeminently  one  of  the  drugs  whose  crude  forms  should  be  retired 
from  the  shelves  of  the  pharmacy. 

.  Zeissl  obtained  colchicine  by  treating  the  seed  with  90  per  cent 
alcohol ;  the  alcohol  was  then  removed  and  the  residue  dissolved  in 
distilled  water,  and  shaken  up  with  chloroform  absolutely  free  from 
hydrochloric  acid.  When  the  chloroform  is  distilled  off  there  re- 
mains a  syrupy  residue,  which  on  strong  cooling,  deposits  rosette 
crystal-groups.  This  is  purified  by  adding  small  quantities  of  pure 
chloroform;  the  colchicine  is  taken  up  in  a  large  quantity  of  the 
same  solvent,  condensed,  mixed  with  ether,  and  from  this  crystal- 
lized. The  result  is  a  combination  of  colchicine  with  two  mole- 
cules of  chloroform,  the  formula  being  C2oH25NO62CHCl3.  On 
evaporation  chloroform  is  given  off,  but  not  all  even  on  prolonged 
heating.  The  crystals  are  luminous  in  the  dark.  When  free  from 
chloroform,  colchicine  is  amorphous,  bright  yellow,  darkening  on 
exposure  to  light,  with  strong  electric  qualities  when  triturated. 
Zeissl's  colchicine  is  laevogyrous.  The  addition  of  mineral  acids,  or 
boiling  with  alkalies,  splits  off  a  methoxyl  group,  leaving  colchiceine, 
or  aceto-trimethyl-colchicinic  acid. 

On  heating  colchicine  with  hydrochloric  acid  to  302  F.,  am- 
monia is  split  off.  Colchicine  gives  no  salt  with  acids,  and  is  not 
precipitated  with  platinum  chloride.  Concentrated  nitric  acid  dis- 


164.  COLCHICINE 

solves  it,  giving  first  a  violet,  then  a  yellow  color.  Sulphuric  acid 
containing  nitric  acid  gives  at  first  a  yellow-green,  passing  over 
gradually  to  green,  blue,  wine-red,  then  again  yellow,  and  on  addi- 
tion of  concentrated  caustic  soda  solution,  it  becomes  red.  Bromine 
water  gives  a  yellowish  precipitate,  and  potassium  iodide  a  brown. 
Boiled  in  iron  chloride  it  colors  this  acid  solution  green  to  dark 
green,  and  shaken  up  with  chloroform  this  becomes  brownish  to 
red.  Mercuric  chloride  produces  in  the  hydrochloric  solution  a 
lemon-yellow  precipitate,  as  do  gold  chloride,  cadmium  iodide, 
potassio- mercuric-iodide,  potassium  bismuth  iodide  (yellow  to 
brown),  phosphor-wolf  ramie  and  phosphor-molybdenic  acids.  Po- 
tassium chromate  and  sulphuric  acid  give  a  dirty  orange-yellow  pre- 
cipitate. Tannic  acid  gives  a  white  precipitate.  Picric  acid  gives  no 
precipitate.  Solution  of  phenol  gives  a  milky  coloring,  which  after 
some  time  condenses  into  resinous  little  drops. 

Colchiceine  gives  salts  with  bases  and  acids,  and  with  gold 
chloride  a  double  salt.  In  the  same  way  colchicinic  acid,  dimethyl 
and  trimethyl  colchicinic  acids  combine  with  acids  and  bases  (Lie- 
breich). 

Physiologic  Action. — Two  to  six  hours  elapse  after  its  adminis- 
tration before  effects  are  manifest.  Given  by  the  stomach  or  sub- 
cutaneously  in  toxic  doses  gastric  and  intestinal  discomfort  are  felt, 
then  gastric  pain,  salivation,  nausea,  vomiting  and  diarrhea.  The 
dejecta  become  mucous  and  blood-streaked,  the  vomit  becomes 
bloody,  skin  covered  with  cold  sweat.  Depression,  apathy  and  col- 
lapse follow;  motion  becomes  difficult,  especially  in  the  legs,  the 
motor  paralysis  becoming  complete  and  creeping  up  until  it  reaches 
the  respiratory  centers,  causing  death  by  asphyxia.  Muscular  pains 
may  replace  the  spasms  (Wood).  Reflex  action  is  depressed 
(Albers).  Vertigo  and  anxiety  are  usual,  and  sometimes  confusion 
or  delirium  precedes  collapse,  but  usually  the  mind  is  clear  till 
death.  The  largest  doses  finally  paralyze  vagus-inhibition 
( Brunton  ) . 

The  pulse  becomes  small  and  rapid  in  collapse,  but  there  is  no 
direct  action  on  the  circulation. 

Respiration  is  at  first  deep  and  full,  becoming  shallow,  death 
being  due  to  paralysis  of  this  center.  The  heart  beats  after  death. 
The  bowel-action  is  hurried  by  increased  irritability  of  the  nervous 
mechanism  (Jacobj)  ;  and  the  mucosa  is  also  irritated  (Cushny). 
The  muscles  are  affected  as  by  veratrine,  becoming  quickly  fatigued. 
Locally  applied  colchicine  is  intensely  irritant.  Cushny  attributes 


COLCHICINE  165 

the  nervous  symptoms  to  the  collapse  produced  by  the  gastro- 
intestinal irritation,  with  no  direct  cerebral  depression.  So  also  the 
collapse  is  attended  by  a  consequent  sensory  paralysis. 

Small  doses  increase  the  urinary  fluid,  the  urea  and  uric  acid 
excreted,  but  larger  ones  lessen  or  stop  the  fluid  secretions*  (Paton). 
Hematuria  occurs  in  animals.  The  symptoms  are  attributed  by 
Cushny  to  the  excretion  of  the  colchicine  by  the  bowels  and  the  kid- 
neys, and  consequent  irritation  of  these  structures.  Excretion  may 
be  concentrated  upon  either.  Brunton  places  colchicine  among  the 
most  powerful  hepatic  stimulants;  in  large  doses  also  stimulating 
intestinal  secretion  and  peristalsis.  He  ranks  it  also  as  an  alterative, 
improving  nutrition  in  an  unknown  manner;  and  as  a  hydragogue 
diuretic.  The  effects  are  more  marked  on  carnivora  than  on 
herbivora. 

In  man  colchicum  rarely  causes  more  damage  than  a  duodenal 
catarrh.  In  animals  poisoned  by  this  drug  the  postmortem  shows* 
evidences  of  acute  gastro-enteritis,  ecchymoses,  free  blood  in  the 
alimentary  canal,  the  blood  dark  and  coagulating  with  difficulty. 

Brunton  says  that  in  continued  non-toxic  doses  it  causes 
anorexia,  faucial  irritation,  flatulence,  loaded  tongue,  uneasiness  and 
pain  in  stomach  and  bowels;  nausea  and  diarrhea,  slow  pulse  and 
muscular  debility. 

Mairet  and  Combemale  state  that  in  doses  of  0.0002  to  0.0003, 
colchicine  causes  in  healthy  men  mild  headache,  muscular  weakness, 
abdominal  pains,  rapid  pulse,  thirst  and  diuresis ;  in  doses  of  0.005, 
diarrhea  and  oliguria. 

Van  Renterghem  took  0.0005  of  colchicine,  every  half-hour  for 
20  doses.  Slightly  increased  peristalsis  alone  occurred.  An 
arthritic  patient  took  the  same  dose  every  hour  for  five  days,  in 
which  he  took  0.035  in  all,  occasioning  dyspeptic  symptoms,  not 
severe,  subsiding  on  discontinuing  the  medicament.  Colchicine  ad- 
ministered hypodermically  does  not  manifest  its  action  for  an  hour. 
In  slowness  of  getting  to  work  it  contrasts  with  the  promptness  of 
veratrine. 

Veratrine,  aconitine,  emetine  and  digitalin  are  in  certain 
conditions  synergistic  to  colchicine.  Morphine  neutralizes  some  of 
the  effects,  but  favors  the  absorption  of  colchicine  by  soothing 
mucous  irritability. 

Colchicine  is  contraindicated  by  gastric  or  intestinal  irritability, 
and  when  its  use  is  followed  by  over-action,  by  pains,  colics,  etc. 


166  COLCHICINE 

It  should  be  contraindicated  in  phthisis,  but  observations  x  on  this 
point  are  wanting. 

Most  of  the  experiments  made  with  colchicine  are  valueless,  be- 
cause the  experimentors  failed  to  observe  sufficiently  the  variations 
of  diet,  by  which  the  elimination  of  urea  and  uric  acid  would  be  in- 
fluenced. Besides,  under  the  name  of  colchicine  a  number  of  mix- 
tures were  employed,  containing  colchiceine,  chloroform,  and  numer- 
ous by-products.  Paschkis  employed  a  pure  colchicine,  and  his  re- 
sults, confirmed  in  the  main  by  Rossbach,  are  therefore  to  be  ac- 
corded more  respect  than  others.  Paschkis  could  detect  no  increase 
of  blood-pressure  from  colchicine,  but  in  cases  showing  abnormally 
high  pressure  the  drug  occasioned  a  diminution.  Sensibility  was 
also  reduced. 

The  conflicting  testimony  in  regard  to  colchicine  may  be  sum- 
med up  in  the  statement  that  small  doses  increase  the  excretion  of 
urine,  as  far  as  relates  to  the  water,  the  urea  and  the  uric  acid ; 
while  large  medicinal  doses  cause  vomiting  and  diarrhea,  due  to  the 
excretion  of  the  drug  through  the  mucous  membrane  of  the  stomach 
and  bowels.  As  colchicine  acts  far  more  vigorously  on  carnivora, 
it  is*  probable  that  it  is  more  effective  in  those  who  eat  too  much 
nitrogenous  food.  Does  colchicine  increase  the  internal  secretion  of 
the  kidneys  or  of  the  other  organs  ?  It  is  not  found  in  the  bile ;  but 
Shaller  states  that  bile  is  always  present  in  the  evacuations  produced 
by  colchicine,  and  as  it  relieves  hepatic  congestion  it  evidently  in- 
creases the  activity  of  the  liver.  But  as  hepatic  torpor  is  often  as- 
sociated with  uricacidemia,  the  relief  may  be  secondary  to  the  gen- 
eral benefit  of  the  increased  excretion.  And  yet  as  urea  is  a  product 
of  the  liver,  does  colchicine  increase  the  production  or  simply  the  ex- 
cretion of  the  bile?  These  queries,  unanswerable  at  present,  show 
how  superficial  has  been  the  study  of  even  the  most  popular  articles 
in  our  materia  medica. 

Shaller  says  that  colchicine  increases  the  secretions  of  the  liver, 
intestines,  kidneys  and  skin. 

Therapeutics. — In  gout  colchicine  has  won  the  reputation  of  a 
specific,  and  especially  in  the  acuter  manifestations  of  this 
affection.  The  usual  method  was  to  administer  enough  of  the  drug 
to  produce  decided  action  on  the  stomach  or  bowels ;  and  with  this 
the  acute  pain  and  other  evidences  of  the  attack  subsided.  Whether 
colchicum  is  effective  against  the  chronic  forms  of  gout  is  not  so 
clear,  since  victims'  of  this  malady,  if  relieved  of  the  pains,  are  apt 
to  indulge  in  the  pleasures  of  the  table  to  a  still  greater  extent.  But 


COLCHICINE  167 

when  the  proper  balance  between  the  diet  and  the  exercise  is  main- 
tained, colchicine  will  prove  of  great  assistance  in  eliminating  from 
the  body  its  excess  of  uric  acid. 

In  America  gout  is  represented  by  uricacidemia,  and  in  the 
multifarious  manifestations  of  this  diathesis,  colchicine  is  the  first 
of  remedies.  It  is  not  necessary  to  push  the  drug  to  the  production 
of  unpleasant  effects.  Let  the  granules  be  taken  until  slight  loose- 
ness of  the  bowels  is  evident,  and  then  suspend  the  medication  until 
the  next  day.  The  daily  dose  thus  ascertained,  may  be  divided  into 
three  and  taken  before  meals  in  the  usual  way. 

Colchicine  is  more  rapidly  absorbed  than  the  galenic  prepara- 
tions of  colchicum,  but  the  slowness  of  its  action  renders  this  agent 
ill  fitted  for  rapid,  cumulative  administration ;  so  that  the  doses 
should  be  at  least  two  hours  apart.  So  numerous  are  the  manifesta- 
tions of  uricacidemia,  myalgic  pains,  headaches,  catarrhs  acute  and 
chronic,  itching  and  other  irritations  of  the  skin,  gastro-intestinal 
catarrhs  with  the  numerous  train  of  ailments  pertaining  thereto,  that 
one  cannot  go  far  wrong  in  prescribing  colchicine  for  a  plethoric 
person,  or  a  carnivorous  individual,  complaining  of  these  or  of  any 
anomalous  ailment.  And  in  this  land,  where  most  persons  eat  meat 
twenty-one  times  a  week,  there  is  perhaps  no  agent  more  generally 
useful. 

The  great  objection  to  colchicine  is  its  remarkable  efficiency. 
The  melancholy,  dullness,  sluggishness,  anorexia,  bad  breath, 
"tired  feeling,"  are  so  promptly  dissipated  by  a  few  granules  of 
colchicine,  that  the  patient,  perhaps  unconsciously,  increases  his  con- 
sumption of  meat  and  relaxes  his  exercise,  relying  on  the  daily  dose 
of  colchicine  to  keep  him  comfortable.  It  would  be  far  better  to 
forego  the  aid  of  all  drugs,  and  let  nature  punish  the  slothful  glutton 
until  he  is  driven  back  to  hygienic  living. 

Abbott  reports  excellent  results  in  pleurisy  occurring  in  rheu- 
matics, from  colchicine  combined  with  aconitine  and  bryonin. 

In  gout,  colchicine  acts  best  with  or  following  purgatives 
(Brunton). 

In  rheumatic  gout,  colchicine  and  iodides  give  some  relief 
(Brunton). 

Butler  advises  colchicine  in  full  doses  for  ascites  from  hepatic 
obstruction,  and  mentions  its  use  in  gonorrhea,  chordee,  hypo- 
chondria with  renal  insufficiency,  ocular  inflammations,  and  local 
manifestations  of  gout.  Abadie  found  colchicine,  o.ooi  two  to  four 
times  daily,  of  value  in  scleritis.  Woodbury  injects  it  into  the  nerve- 


168  COLLINSONIN 

sheath  in  sciatica,  but  Butler  condemns  this  on  account  of  the  severe 
local  irritation. 

Treatment  of  colchicine  poisoning:  Empty  the  stomach  and 
bowels  if  not  already  done,  giving  abundance  of  warm  water.  Tan- 
nic  acid  is  the  only  known  chemical  antidote;  it  is  not  reliable  but 
give  it  freely.  Check  vomiting  and  purging  by  morphine.  Allay 
irritation  by  white  of  egg  in  water.  Treat  symptoms  as  they  arise. 
External  heat.  Atropine.  Stimulants. 

Dosage:  In  acute  gout  and  rheumatism,  Shaller  advises  0.0005 
to  o.ooi,  every  hour,  or  oftener  in  robust  cases,  with  aconitine,  until 
the  pain  and  fever  are  subdued,  or  the  bowels  thoroughly  moved. 
After  full  action  the  doses  should  be  reduced  and  the  benzoates 
added.  Delicate  patients  should  take  the  drug  less  frequently.  In 
chronic  rheumatism  with  stiffness  of  the  joints  bryonin  is  a  useful 
adjuvant.  He  reports  two  cases  of  obstinate  sciatica  cured  by 
colchicine,  o.ooi  every  two  hours  till  free  purgation,  then  0.0005 
every  three  hours.  In  rheumatic  neuralgia,  quinine  arsenate  o.oi, 
should  be  added  to  each  dose. 

Merck  gives  the  dose  of  his  colchicine  as  0.005  to  0.0022,  two 
or  three  times  a  day.  I  have  rarely  found  it  advisable  to  give  more 
than  0.0005  f°ur  times  a  day,  and  this  will  be  too  much  for  persons 
with  delicate  stomachs.  In  acute  gout  or  the  cerebral  congestions  of 
plethoric  persons,  where  a  strong  and  speedy  effect  is  required,  give 
o.ooi,  dissolved  in  hot  water  and  repeated  in  two  hours.  Gelsemin, 
veratrine  or  lobelin  may  be  added  in  cases  requiring  speedy  relaxa- 
tion. 

COLLINSONIN. 

Standard  granule — Gr.  1-6,  gm.  .01. 

Collinsonin  is  a  'concentration  from  Collinsonia  Canadensis, 
stone-root.  The  composition  of  this  remedy  has  never  been  studied, 
except  that  Lochman  found  in  it  a  volatile  oil. 

Therapeutics. — Felter  and  Lloyd  consider  it  alterative,  tonic, 
stimulant  and  diuretic,  acting  principally  on  the  veins  and  mucosa, 
but  sedating  irritation  of  the  vagus.  Minute  doses  of  the  green 
plant  cause  prompt  emesis.  Poultices  of  the  leaves  have  been  ap- 
plied for  a  great  variety  of  affections,  external  and  internal.  It  has 
been  given  for  the  whole  line  of  uterine  maladies,  amenorrhea,  dys- 
menorrhea,  menorrhagia,  vicarious  menstruation,  prolapsus  uteri, 
leucorrhea,  threatened  abortion,  and  even  pruritus  vulvae,  dependent 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


COLLINSONIN  169 

on  varicosities1.  It  is  an  old  remedy  for  gravel,  useful  in  cystitis, 
spermatorrhea  and  varicocele  when  accompanied  by  piles.  All 
catarrhs  are  benefited  by  it,  even  the  cough  of  phthisis.  Ministers' 
sore  throat  is  especially  benefited  by  it ;  as  is  aphonia,  chronic  laryn- 
gitis, bronchitis,  etc.  In  diseases  of  the  gastrointestinal  tract  it  re- 
lieves irritation,  improves  digestion,  promotes  the  flow  of  gastric 
juice  and  gives  tone  to  the  weak  tissues.  Piles  always  increase  the 
indication.  The  most  marked  symptoms  calling  for  it  are  constric- 
tion, heat  and  weight  in  the  rectum,  dry  scybalous  feces,  in  pregnant 
women,  and  piles  with  rectal  irritation  but  no  constipation.  In  con- 
stipation collinsonin  is  useful  from  its  tonic  action  on  the  rectal 
tissues. 

Other  conditions  for  which  these  authors  recommend  it  are  sub- 
acute  proctitis,  tenesmus  of  dysentery,  dysenteric  cholera  infantum, 
rectal  pain  and  inflammation  after  operations ;  irritation  of  anal 
fistulas,  ulcers  and  pockets ;  neurotic  rectal  pains,  hypogastric  pains 
not  vesical,  all  if  associated  with  rectal  capillary  congestion ;  in  atonic 
dyspepsia  and  chronic  disease  with  feeble  digestion  it  act&  as  a  tonic 
and  stimulant,  and  increases  secretion  from  skin  and  kidneys,  reliev- 
ing nervous  irritation  and  increasing  innervation  (Scudder). 

In  chronic  pulmonary  diseases  it  relieves  irritation  and  stimulates 
expectoration ;  quiets  pneumogastric  irritation,  that  of  heart  disease 
and  the  asthma  attending  or  simulating  phthisis,  and  strengthens 
and  regulates  the  circulation;  is  serviceable  in  hydropericardium, 
rheumatic  heart-diseases  and  functional  affections  due  to  gastric  ir- 
ritation ;  mitral  regurgitation  and  the  cough  of  heart  disease  are 
greatly  benefited  by  it ;  lack  of  tonicity  of  the  blood-vessels  is  over- 
come— in  short,  passive  vascular  engorgement,  with  dilated  capil- 
laries, torpid  portal  circulation  and  lack  of  muscular  tonicity,  call  for 
stone-root. 

Foltz  advises  collinsonin  for  ear  diseases  with  increase  of  secre- 
tion but  not  pus,  and  when  follicular  pharyngitis  or  hypertrophy  of 
Luschka's  gland  is  present. 

Scudder  gives  as  indications  for  collinsonin:  A  sense  of  con- 
striction with  irritation  in  throat,  larynx  or  anus;  or  with  tickling 
in  throat,  cough  on  talking;  sense  of  foreign  body  in  rectum  with 
contraction  of  sphincter  and  contracted  and  painful  perineum. 

Ellingwood  ranks  collinsonia  among  the,  stomachics,  and  at- 
tributes to  it  a  tonic  influence  over  the  heart  muscle,  the  walls  of  the 
veins  and  dilated  capillaries.  He  terms  it  a  specific  for  hemorrhoids, 
which  if  recent  can  be  cured  in  three  days  to  a  week  by  collinsonia. 


1VO  COLOCYNTHIN 

He  combines  it  with  hamamelis,  and  gives  before  and  after  opera- 
tion. Collinsonia  is  of  value  in  the  hemorrhoids  of  pregnancy ;  also 
for  rectal  pain  from  any  cause;  specific  for  pain  in  the  lower  bowel, 
persistent  and  steady.  In  bladder  affections  it  is  only  useful  when 
the  walls  are  relaxed  and  distended.  In  bicycle  heart  it  is  useful, 
with  cactus.  In  passive  hemorrhages  also  he  gives  it  with 
hamamelis. 

Shoemaker  recommends  collinsonia  as  a  useful  local  astringent ; 
as  a  stomachic  tonic  in  alcoholism,  lessening  the  appetite  for  liquor ; 
as  an  antispasmodic  in  croup  and  whooping-cough,  chorea,  anal 
sphincter  spasm  with  hemorrhoids,  etc. ;  some  cases  of  dysmenor- 
rhea,  for  which  he  advises  this  remedy  for  a  week  preceding  and 
during  the  flow ;  in  vaginal  suppositories  for  vaginismus ;  renal  and 
biliary  colic ;  infantile  and  flatulent  colics ;  in  acute  cystitis,  with 
aconite  and  morphine,  it  is>  more  rapidly  efficacious  than  any  other 
treatment.  For  incontinence  of  urine  in  children,  and  when  in  adults 
there  is  a  dripping  of  a  few  drops  of  urine  after  urination  is  ap- 
parently concluded,  collinsonia  relieves  effectually.  It  arrests  the 
discharge  of  chronic  gonorrhea  when  the  customary  remedies  fail. 
It  has  also  succeeded  in  curing  leucorrhea  and  prostatorrhea. 

From  this  we  gather  that  collinsonin  is  an  astringent,  specially 
affecting  the  veins  and  capillaries  as  hamamelin  does.  But  there  is 
more  than  this  in  it — tannic  and  gallic  acids  do  not  give  the  effects 
detailed.  The  hint  as  to  its  use  in  the  elderly  bladder  is  important. 
It  may  aid  in  postponing  catheter  life  somewhat. 

The  dose  of  collinsonin  is  gr.  1-6  to  iv,  every  two  hours.  The 
galenic  preparations  are  so  variable  that  it  is  impossible  to  give  an 
approximation  to  their  dosage.  Webster  prefers  a  tincture  of  the 
green  plant,  but  most  writers  use  the  infusion,  or  Lloyd's  specific,  of 
which  the  dose  is  gtt.  i-io  to  15. 

COLOCYNTHIN. 

Standard  granule — Gr.  1-134,  gm.  .0005. 

Colocynthin,  a  glucoside,  is  derived  from  the  colocynth,  and 
represents  its  remedial  powers.  The  yield  is  about  0.6  per  cent 
(Henke). 

In  small  doses  cqjocynthin  is  a  sure  and  powerful  cathartic, 
stimulating  at  once  the  intestinal  peristalsis  and  the  mucous  secre- 
tion. The  increase  in  the  urinary  secretion  noted  especially  after 
large  doses  may  be  due  to  a  local  action,  colocynthin  being  elim- 


COLOCYNTHIN  171 

inated  by  the  kidneys,  or  to  derivation :  The  free,  watery  stools  re- 
lieve the  abdominal  viscera  of  abnormal  pressure,  the  renal  veins 
are  unloaded,  and  the  movement  of  blood  through  the  renal  arteries 
allows>  a  freer  flow  of  urine  (Van  Renterghem).  Hufeland  counted 
colocynth  among  the  most  powerful  of  diuretics. 

Sobernheim  credits  colocynthin  with  a  predilection  for  the  ab- 
dominal ganglionic  system  and  the  inferior  medullary  plexus.  He 
thus  explains  its  beneficial  effects  upon  paralysis  of  the  lower  ex- 
tremities, the  rectum  and  bladder.  This  action  is  in  part  alterative, 
in  part  stimulant,  and  presents  some  analogy  with  that  of  the  acrid 
narcotics.  In  fact,  when  we  increase  the  doses  of  colocynthin  we 
get  symptoms  of  narcotic  poisoning — heaviness  of  the  head,  vertigo, 
delirium,  cloudy  vision,  deafness,  etc. 

Excessive  doses  cause  small  bloody  stools,  acute  colic,  tenesmus, 
nausea,  vomiting,  tension  and  excessive  sensibility  of  the  abdomen, 
complete  suppression  of  the  stools  and  urine,  retraction  of  the 
testicles,  priapism  and  death  (Gubler). 

On  autopsy  we  find  signs  of  gastroenteritis,  and  traces  of  in- 
flammation of  the  liver,  spleen  and  kidneys. 

The  action  of  colocynthin  is  chiefly  manifested  in  the  large  in- 
testine, the  colon  rather  than  the  rectum.  It  stimulates  the  secretion 
of  bile  more  than  does  jalap  or  croton  oil  (Rutherford). 

Given  in  fractional  doses  colocynthin  does  not  exhibit  the  drastic 
action  of  large  doses.  Give  gr.  1-30  to  1-20,  three  times  a  day,  it 
incites  the  physiologic  action  of  the  colon ;  repeat  these  doses  more 
frequently  and  it  causes  hyperpurgation. 

Colocynthin  is  too  bitter  to  be  given  in  solution.  It  is  not  suita- 
ble for  chronic  constipation,  as  if  long  administered  or  in  excessive 
doses  it  may  occasion  ulceration  of  the  bowel.  Large  doses  may 
cause  collapse  in  feeble  patients. 

Therapeutics. — Colocynthin  is  used  as  a  hydragog,  with  others  of 
this  group ;  and  for  dropsies  due  to  retention  of  abdominal  glandular 
secretions  or  to  portal  obstruction,  especially  when  attended  by 
chronic  nephritis.  In  small  doses  it  is  useful  to  favor  the  action  of 
colon  digestion.  The  usual  dose  is  gr.  1-30  after  meals.  It  acts 
when  given  hypodermically  or  intravenously,  and  in  the  latter  case 
too  large  doses  cause  nephritis.  In  fact,  this  is  said  to  occur  when 
this  drug  is>  inhaled  in  the  process  of  manufacture. 

The  powerful  derivation  by  colocynthin  may  be  utilized  to  re- 
lieve the  hyperemic  brain.  When  sciatica,  ovaralgia  or  other  pelvic 
pains  are  due  in  any  part  to  a  loaded  bowel,  colocynthin  will  give 


H2  CONDURANGIN 

relief.  It  may  be  given  in  enema  and  acts  well,  with  no  local  irrita- 
tion. 

The  griping  caused  by  colocynthin  in  large  doses  may  be  pre- 
vented by  giving  with  it  atropine  and  aromatics.  A  good  prescrip- 
tion is  colocynthin  gr.  1-33,  atropine  gr.  1-250,  and  capsicin  gr.  1-67, 
after  each  meal. 

Some  day  it  will  be  found  that  no  two  agents  possess  exactly  the 
same  powers,  or  act  on  precisely  the  same  parts  of  our  organisms. 
It  has  long  been  known  that  we  get  a  better  effect  from  a  union  of 
cathartics  than  from  any  one  alone,  no  matter  how  large  the  dose. 
The  compound  cathartic  pill  has  held  a  high  place  and  still  holds  it, 
despite  the  host  of  rivals  pushed  commercially.  A  moderate  dose  of 
colocynthin,  with  euonymin,  iridin,  leptandrin,  juglandin,  hyos- 
cyamine  and  menthol,  will  give  more  satisfactory  results  as  a  general 
cathartic  than  any  one  of  these  agents  alone. 


CONDURANGIN. 

Standard  granule — Gr.  1-67,  gm.  .001. 

The  discovery  of  the  remedial  properties  of  condurango  is  at- 
tributed to  an  Indian  woman.  Her  husband  was  affected  with  can- 
cer; and  desiring  to  poison  him,  she  administered  a  decoction  of 
condurango  bark.  Instead  of  killing  him,  however,  it  cured  his 
cancer. 

The  plant  is  a  vine,  resembling  the  grape,  but  growing  .  to 
enormous  size.  Ten  varieties  were  described  by  Ruschenberger,  of 
which  but  one,  Condurango  blancho,  is  credited  with  remedial  prop- 
erties, and  this  is  official  in  Germany. 

In  1871,  Drs.  Caesares  and  Eguiguren,  of  Ecuador,  where  the 
plant  is  found,  advocated  it  as  a  remedy  for  cancer,  syphilis  and 
scrofula.  The  Minister  of  Ecuador  brought  it  to  the  notice  of  the 
State  Department,  under  whose  auspices  an  investigation  was  made 
of  the  bark  and  its  properties.  The  mother  of  Vice-President  Col- 
fax  was  alleged  to  be  cured  by  condurango ;  and  this,  with  the  en- 
dorsement of  some  prominent  physicians,  aroused  a  whirlwind  of 
enthusiasm  over  the  drug,  which  was  sold  at  the  rate  of  $100  a 
pound.  Then  the  adverse  reports  came  in ;  Mrs.  Colfax  died  of 
cancer;  and  the  alleged  remedy  fell  into  such  disrepute  that  its  use 
ceased  entirely  in  America. 

Nevertheless,  in  Germany  some  quiet  observers  asked  the  qties- 


CONDURANGIN  173 

tion :  "What  after  all  was  there  in  condurango  to  give  it  such  a 
reputation?"  To  their  efforts  to  answer  we  owe  the  data  presented. 

In  Ecuador  numerous  plants  employed  as  remedies  for  cancer, 
snake-bites  and  syphilis,  are  called  condurango.  The  true  bark  is 
probably  derived  from  Gonolobus  condurango  triana,  of  the 
Asclepias  family.  Two  or  more  glucosides,  possibly  an  alkaloid, 
and  one  or  more  resinoids,  have  been  found  in  this  bark,  the  separa- 
tion of  which  entails  great  difficulties.  Antisell,  Flueckiger, 
Schmiedeberg,  Jukna,  Vulpius,  Reuter  and  Carrara,  have  investi- 
gated the  chemistry  of  condurango,  with  varying  results.  The  lat- 
ter isolated  in  1892  two  bodies:  Soluble  condurangin,  C20  H32  O6, 
and  insoluble  condurangin,  C18  H28  O7. 

Physiologic  Action. — Studies  have  been  made  with  Vulpius'  con- 
durangin and  Jukna's  resin  glucoside  which  act  alike,  the  resin 
being  somewhat  stronger.  Their  effect  is  most  marked  on  the 
central  nervous  system.  Small  doses  disturb  coordination,  the 
movements  becoming  ataxic,  with  great  debility  and  marked  im- 
pulse to  move  about.  Respiration  and  pulse  are  unaffected,  the 
pupils  normal,  the  tendon  and  cutaneous  reflexes  somewhat 
heightened.  The  appetite  is  diminished  or  stopped.  Salivation  and 
emesis  are  frequently  seen. 

Large  doses  excite  primarily,  and  paresis  follows.  There  is  a 
peculiar  stiffness  of  the  extremities.  Violent  cramps  follow,  at  first 
tonic,  then  clonic.  Respiration  becomes  shallow,  the  pulse  rapid, 
the  stiffening  relaxes,  the  cramps  subside,  and  paresis  supervenes. 
Consciousness  and  sensation  seem  to  be  unaffected.  The  pupils 
dilate  during  the  cramps,  but  are  normal  in  the  intervals-.  Respira- 
tion is  retarded  and  superficial,  the  pulse  small,  and  death  occurs 
during  a  convulsive  spasm,  or  from  prostration,  presumably  from 
respiratory  paralysis.  The  cramps  are  due  to  action  on  the  cerebral 
and  medullary  centers,  and  may  be  checked  by  chloroform,  chloral, 
morphine  or  curarine.  The  vomiting  is  also  centric  and  not  reflex. 
Condurangin  does  not  influence  the  heart,  the  arterial  tension  or  the 
intestinal  muscular  fiber.  Direct  contact  with  voluntary  muscle,  or 
with  motor  nerves,  at  first  increases  the  electrical  irritability,  which 
soon  subsides  and  finally  ceases. 

Nothing  characteristic  is  found  on  postmortem.  The  lethal  dose 
for  cats  or  dogs  intravenously  is  0.02 — 0.03,  per  kilo,  weight.  By 
the  stomach  the  lethal  dose  would  be  0.040 — 0.048  per  kilo.  To  kill 
rabbits  the  dose  is  0.03. 

It  is  evident  that  as  yet  nothing  has  been  shown  by  these  studies 


174  CONDURANGIN 

to  in  any  way  clear  up  the  question  of  the  use  of  condurango  in 
cancer;  which  must  be  decided  by  purely  clinical  evidence.  A  sum- 
mary of  this  evidence  we  present. 

Therapeutics. — Wilhelmy  gave  condurango  in  six  cases  of  gastric 
and  one  of  oesophageal  cancer.  Under  its  use  the  pains  were 
materially  reduced  after  the  drug  had  been  taken  one  or  two 
weeks ;  the  appetite  improved,  vomiting  decreased,  and  in  three  cases 
there  was  a  gain  in  weight.  All  but  one  died,  though  material  relief 
had  been  afforded. 

Hoffman  obtained  similar  benefit  in  132  cases.  In  pyloric  cancer 
it  ivas  found  that  prolonged  contact  of  the  drug  with  the  stomach 
ztfalls  was  advisable. 

In  gastric  ulcer  brilliant  results  followed  the  use  of  condurango 
and  iron,  especially  when  anemia  preceded  the  malady.  In  twenty- 
seven  cases  absolutely  diagnosed  (hemorrhagic,  etc.),  this  treatment 
was  used.  Pain  and  hemorrhage  ceased  usually  in  four  days.  The 
drug  was  continued  two  months.  Relapses  were  mild  and  soon 
over.  In  anemia  this  combination  acted  better  than  iron  alone.  In 
acute  and  chronic  gastric  catarrh  good  results  were  obtained. 

Riess  reported  in  fifty  cases  of  dyspepsia,  catarrhal  or  with  dila- 
tation, that  condurango  gave  no  advantage  over  ordinary  bitter 
stomachics,  if  it  were  as  good.  In  carcinoma,  not  gastric,  striking 
benefit  was  rare.  In  thirty  cases  of  peritoneal  carcinoma,  primary 
cancer  of  the  gall-bladder,  or  large  hepatic  metastases,  except  a 
transient  improvement  of  appetite  and  easing  of  pain  there  was  no 
benefit.  In  eight  cancers  of  the  oesophagus,  the  dysphagia  and 
cachexia  were  eased  doubtfully — diet  and  sounds  may  have  been 
the  true  sources  of  benefit. 

Of  pure  gastric  cancer,  with  anorexia,  dyspepsia,  vomiting, 
hematemesis,  cardialgia,  progressive  cachexia  and  in  time  palpable 
tumor,  he  reported  120  cases  observed  personally  and  records  cover- 
ing 800.  In  none  was  the  drug  without  effect.  Even  when  first 
used  in  the  last  stages,  in  the  last  weeks  of  life,  the  appetite  im- 
proved and  euphoria  occurred.  The  effect  is  far  more  striking  when 
the  drug  is  given  four  weeks.  It  is  readily  taken,  well  borne,  with- 
out repugnance,  for  very  long  periods,  to  the  amount  of  10.0  grams 
of  decoction  a  day. 

In  a  few  days  the  appetite  increased,  nausea  disappeared,  and 
vomiting  lessened  and  ceased  if  not  due  to  stenosis  of  the  pylorus 
and  ectasia.  In  eight  to  fourteen  days*  gastric  pains  lessened  with 
hardly  an  exception,  and  finally  disappeared  almost  completely.  As- 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


CONDURANGIN  175 

similation  improved  with  nutrition ;  the  patients  felt  better  and  grew 
.stronger,  often  weighed  more.    In  most  cases  life  was  prolonged. 

Of  108  cases  without  condurango,  70  died,  28  left  unhealed,  10 
left  improved. 

Of  twenty  cases  treated  with  condurango,  ten  died,  two  were 
discharged  unhealed,  eight  improved. 

Of  eighty  condurango  cases  the  average  duration  of  treatment 
was  43.4  days.  Of  these  66.3  per  cent  died,  on  an  average  in  39.5 
days;  33.7  per  cent  were  discharged  after  an  average  treatment  of 
54.8  days,  24  as  improved  and  3  cured. 

Of  116  cases  treated  without  condurango,  the  average  duration 
of  treatment  was  21.2  days.  Of  these  92.2  per  cent  died,  average  22 
days;  7.8  per  cent  were  discharged,  average  11.7  days'  treatment, 
five  improved,  four  not  cured. 

Of  64  cases  in  which  a  palpable  tumor  was  demonstrated,  a  dis- 
tinct decease  in  its*  size  could  be  showr.  resulting  in  complete  or  al- 
most ccr..Dlete  disappearance.  In  all  ~:'"  "*=st  the  growth  of  the 
tumor  ceased.  An  increase  in  size  „/  ine  tumor  was  never  observed 
during  prolonged  condurango  treatment. 

In  three  cases  (two  discharged  as  improved,  one  as  cured) 
autopsies  were  held  for  death  due  to  other  causes,  soon  after  their 
discharge;  and  the  autopsy  confirmed  the  diagnosis  and  the  cure. 
In  other  cases  the  tumor  decreased  in  size  for  a  time  but  the  improve- 
ment ceased,  and  at  death  the  autopsy  confirmed  the  diagnosis. 

Summary:     In  some  cases  condurango  completely  cures  gastric 
cancer  and  other  gastric  maladies ;  in  many  more  it  causes  a  per- 
manent substantial  improvement  of  all  the  chief  symptoms,  dys- 
'pepsia,  vomiting,  cardialgia,  cachexia  and  tumor,  and  prolongs  life. 
In  the  rest  it  caused  at  least  transient  improvement  and  euphoria. 

Binz  recommends  in  cancer  or  its  suspicion,  the  steady  use  of 
condurango.  The  effect  invariably  is  distinctly  local. 

What  other  remedy  affords  as  much  benefit  in  cancer  of  the 
stomach  ? 

Careful  study  of  Riess'  report  fails  to  show  any  reason  to  doubt 
the  correctness  of  his  diagnoses,  nor  that  some  cases  of  gastric 
cancer  were  undoubtedly  cured  by  the  internal  administration  of 
condurango.  But  the  effect  was  distinctly  and  invariably  local ;  and 
here  we  wish  to  make  our  chief  point.  Seemingly  it  has  occurred 
to  no  one  to  use  any  of  the  bodies  derived  from  condurango  hypo- 
dermically,  injected  into  the  cancerous  tissues.  And  yet  it  is  evident- 
ly the  step  to  be  next  taken ;  and  surely  it  is  worth  while ! 


176  CONVALLAMARIN 

The  effects  of  condurango  in  gastric  ulcer  are  also  notable;  but 
there  are  other  remedies  for  this  malady,  whereas  in  cancer  we  are 
assuredly  in  need  of  more  effective  weapons  than  those  now  in  use. 
So  also  in  other  gastric  maladies,  there  has  not  as  yet  been  shown 
any  good  reason  for  substituting  condurango  for  the  prevailing 
treatment. 

Riess  gave  condurango  in  decoction,  10  to  20  parts  in  200,  a 
tablespoonful  several  times  a  day.  Condurangin  separates  by  heat 
and  redissolves  on  cooling;  so  that  the  decoction  should  not  be 
filtered  until  cool. 

Merck  lists  condurangin,  a  mixture  of  the  glucosides.  It  is  an 
amorphous  yellow  powder,  of  aromatic  bitter  taste,  soluble  in  alco- 
hol, water  and  chloroform.  Dose  0.0065  to  0.016  three  times  a  day 
(gr.  i-io — 1-2).  We  would  recommend  o.ooi  (gr.  1-67)  as  the  be- 
ginning dose  hypodermically,  rapidly  increased  to  0.005  or  more,  in 
watery  solution,  injected  into  the  substance  of  any  cancerous  tumor 
in  reach. 

CONVALLAMARIN. 

Standard  granule — Gr.   1-12,  gm.  .005. 

From  the  lily  of  the  valley  are  derived  two  glucosides,  conval- 
larin,  a  cathartic,  and  convallamarin,  on  which  the  heart  tonic 
virtues  of  the  plant  depend.  This  principle  closely  resembles 
digitalein,  being  freely  soluble  in  water. 

Physiologic  Action. — Marme  has  made  the  following  summary  of 
the  action  of  convallamarin  upon  the  vascular  pressure : 

1.  The  normal  arterial  pressure  is  augmented,  generally  with 
slowing  of  the  pulse. 

2.  This  increased  pressure  continues  while  the  pulse  becomes 
faster  than  normal. 

3.  The  pressure  continues  high   while  the  pulse  becomes   ir- 
regular in  frequency  and  in  force. 

4.  The  pressure  falls  swiftly,  the  heart  is  arrested,  and  the  sub- 
ject dies. 

The  action  of  convallamarin  is  especially  directed  to  .the  heart 
and  is*  according  to  Boehhi  absolutely  independent  of  vasoconstric- 
tion  from  excitation  of  the  vasomotor  nerves. 

Van  Renterghem  records  the  following  observations  made  on  his 
own  person  with  Merck's  convallamarin. 

The  first  day  he  took  gr.  1-12  every  half-hour  till  20  doses  had 
been  taken.  No  effect  was  manifested  except  that  by  evening  the 


CONVALLAMARIN  177 

pulse  was  more  developed.  Next  day  the  dose  was*  doubled.  In 
the  afternoon,  rattling  in  the  stomach;  in  the  evening-  two  soft 
stools,  no  abdominal  pain — that  day  he  had  taken  no  saline  in  the 
morning.  The  pulse  was  82  in  the  morning,  80  at  10  p.  m.  During 
the  night,  one  soft  stool. 

Third  day:  Took  gr.  ffi,  between  n  a.  m.  and  9  p.  m.  The 
pulse  gained  in  energy  but  the  rate  was  unaltered.  Digestion  was 
unaltered  except  for  the  increased  peristalsis. 

During  the  day  there  were  five  small  stools,  in  the  evening  some 
abdominal  pains ;  during  the  night  two  more  stools.  Next  morning 
he  took  a  saline,  as  in  spite  of  the  taxation  he  felt  some  toxemic 
fever.  The  pulse  was  more  forcible  than  usual  and  the  rate  was  up 
to  no.  Temp.  99.3,  heart  and  temples  beat  strongly;  slept.  Awak- 
ened at  i  a.  m.  by  a  violent  peal  of  the  bell,  he  was  obliged  to  go  in 
a  carriage  a  quarter  of  an  hour,  during  a  "time  of  ice,"  for  a  labori- 
ous confinement  ended  by  the  forceps.  The  duty  was  performed 
with  difficulty;  the  traction  fatigued  beyond  measure  and  caused 
nausea  with  difficulty  restrained.  The  heart  and  arteries  beat 
strongly  and  more  frequently.  By  7  a.  m.  the  rapidity  of  the  pulse 
had  lessened ;  at  8  two  good  stools  and  sufficient  urine,  after  saline. 
At  9  a.  m.  cafe  au  lait.  The  pulse  was  perfectly  calm  and  had  fallen 
to  80.  No  abdominal  symptoms. 

His  conclusion  was  that  doses  of  gr.  1-12  to  1-6  every  hour  do 
not  lessen  the  pulse  rate,  but  increase  its  force  with  the  increase  of 
arterial  pressure.  Doses  of  gr.  1-3  to  2-3,  repeated,  produce  the 
beginning  of  paralysis  of  the  pneumogastric  nerve,  as  shown  by 
feverish  rapidity  of  the  heart  beats.  No  marked  effect  was  noted  on 
the  renal  functions.  The  drug  evidently  did  not  accumulate  in  the 
body. 

Shoemaker  says  that  convallamarin  sometimes  causes  hemop- 
tysis, dyspnea  and  other  disagreeable  symptoms. 

Therapeutics. — Convallamarin  has  been  used  in  heart  diseases, 
especially  those  of  the  mitral  valve.  When  compensation  fails  it 
strengthens  the  heart,  increases  the  excretion  of  urine,  and  quickly 
relieves  dyspnea  and  palpitation.  In  angina  pectoris  and  functional 
affections  of  the  heart  it  has  also  proved  beneficial. 

Janowski  recommended  it  in  renal  and  cardiac  dropsies.  In  cir- 
rhosis of  the  liver  it  acts  as  a  diuretic.  In  chronic  nephritis  it 
strengthens  the  circulation,  relieves  dyspnea,  increases  the  urine,  re- 
duces dropsy  and  lessens  albuminuria  (Shoemaker).  We  may 
doubt  whether  its  occasional  good  effect  in  asthma  is  due  to  a  relaxa- 


178    ,.  COPPER   ARSENITE 

tion  of  arterial  spasm.  More  likely  it  is  in  cardiac  asthmas  that  con- 
vallaria  finds  a  place. 

It  is  sometimes  useful  in  neuralgias,  insomnia,  and  to  quiet  the 
restlessness  of  fever.  The  palpitation  and  dyspnea  of  febrile  phthisis 
are  mitigated  by  it. 

See  valued  convallamarin  above  all  other  remedies,  even  digitalin, 
in  cardiac  dropsies. 

King  gives  as  specific  indications  for  it :  Heart  irregularities 
due  to  mechanical  impediments ;  mitral  insufficiency ;  dropsy  of 
cardiac  origin ;  palpitation  and  vehement  heart  action,  with 
arrhythmic  movements,  dyspnea  and  diminished  arterial  pressure; 
quickened  pulse  with  capillary  obstruction. 

The  place  of  convallamarin  may  be  summed  up  by  saying  that 
it  replaces1  digitalin  in  the  whole  line  of  its  action  and  uses,  but  does 
not  unsettle  the  stomach  as  the  foxglove  sometimes  does,  and  acts 
on  the  bowels  slightly.  When  of  good  quality  it  may  be  used  as  an 
alternant  with  digitalin.  But  we  have  found  no  evidence  to  show 
any  further  applications  in  therapeutics. 

COPPER  ARSENITE. 

Standard  granules — Gr.  1-250,  gm.  .00025 ;  Rr-  i-iooo,  gm.  .000062. 

This  is  a  well-known  remedy  for  all  acute  derangements  of  the 
intestine.  It  has  been  recommended  highly  in  "indigestion"  espe- 
cially when  pain  is  experienced  after  eating.  Its  chief  use,  how- 
ever, is  as  an  antidysenteric :  Gr.  i-iooo — or  even  a  smaller  dose — 
may  be  given  every  fifteen  minutes  for  four  to  six  doses  and  then 
the  same  quantity  repeated  every  hour  or  two.  The  indications  are 
all  forms  of  acute  diarrheas,  cholera  infantum  especially  yielding  to 
this  remedy  if  the  bowel  is  first  cleansed  thoroughly.  In  this  dis- 
ease the  drug  should  be  administered  in  small  but  often-repeated 
doses.  Gr.  i-ioo  may  be  dissolved  in  twenty  teaspoonfuls  of  wa- 
ter and  a  teaspoonful  given  every  ten  minutes  for  three  or  four 
doses  and  then  every  hour  till  relief.  In  a  short  time  tenesmus  and 
tympanites  cease,  the  stools  become  less  frequent  and  those  which 
are  passed  are  free  from  the  typical  odor  which  the  early  dejections 
present.  In  the  more  chronic  diarrheas  and  dysentery,  gr.  1-500  or 
even  gr.  i-ioo  may  be  given  every  three  hours  till  a  marked  im- 
provement is  noticeable. 

The  drug  is  also  recommended  as  a  remedy  for  dysmenorrhea 
and  sometimes  its  administration  is  followed  by  marked  improve- 


CORNIN  179 

ment.     Gr.   i-ioo  may  be  given  three  times  daily  for  three  days 
prior  to  and  during  the  early  part  of  the  menstrual  period. 

/ 
COKNIN. 

Standard  granule — Gr.  1-6,  gm.  .01. 

Cornin  is  a  concentration  from  the  Cornus  florida,  or  dogwood. 
Geiger  obtained  from  this  bark  a  bitter  crystalline  principle,  cornine ; 
soluble  in  water  and  alcohol. 

Felter  and  Lloyd  state  that  dogwood  is  tonic,  astringent  and 
slightly  stimulant.  It  has  been  much  used  as  a  substitute  for 
quinine  in  ague,  and  in  typhoid  fevers.  It  increases  the  strength 
and  frequency  of  the  pulse,  and  elevates  the  bodily  temperature.  It 
relieves  quinine  headaches,  pyrosis  and  general  exhaustion. 

Specific  Indications. — Tonic  antiperiodic,  intermittent  and  mias- 
matic fevers ;  pyrosis ;  quinine  headache ;  general  exhaustion ;  feeble 
relaxed  tissues ;  feeble  pulse  and  subnormal  temperature ;  quinism. 

Ellingwood  advises  cornus  for  atony  of  the  gastrointestinal 
glands  in  malaria,  and  to  antidote  the  malarial  poison ;  increasing 
appetite,  it  improves  digestion,  relieves  drowsiness  and  dullness  fol- 
lowing imperfect  digestion;  also  improves  intestinal  digestion. 

This  meager  account  gives  very  little  information  as  to  this  rem- 
edy, which  we  are  convinced  is  worthy  of  extended  investigation. 
For  some  years  the  writer  has  given  cornin  for  weakness  of  the 
erectile  tissues,  and  believes  it  the  best  remedy  for  this  condition  yet 
introduced — far  superior  to  yohimbine.  The  effect  of  cornin  is  that 
of  a  tonic,  slow  to  be  manifested  but  enduring  long.  The  dose  for 
this  purpose  is  a  grain  four  times  a  day,  and  it  should  be  continued 
a  month  at  least.  It  is  by  no  means  a  cure-all,  for  the  condition  may 
depend  on  any  one  or  more  of  several  pathologic  elements,  and  each 
case  requires  study.  With  many  men  the  restoration  of  power  is  fol- 
lowed by  renewal  of  the  excesses  that  first  induced  the  exhaustion, 
and  this  obviously  will  not  be,  and  should  not  be,  cured  by  any 
treatment.  But  cornin  is  a  valuable  agent  in  restoring  erectile  tissue 
when  not  entirely  beyond  the  reach  of  remedies. 

This  points  to  the  probable  value  of  cornin  in  other  forms  of 
debility,  and  altogether  this  agent  deserves  study  at  the  hands  of 
those  who  do  not  consider  the  whole  story  of  the  tonics  comprised 
by  iron,  strychnine,  quinine  and  cod-liver  oil. 

As  a  remedy  for  ague  cornus  was  employed  largely  in  the  South 
during  the  civil  war,  and  gave  satisfaction.  But  the  crude  prepara- 


180  CORNUTINE 

tions  alone  to  be  had  were  brought  into  competition  with  the  modern 
representative  of  Peruvian  bark,  quinine,  and  obviously  only  de- 
cided superiority  could  overcome  such  a  handicap.  The  crystalline 
cornine  should  be  isolated  and  tested  fully  by  modern  methods. 

CORNUTINE. 

In  1884  Robert  discovered  cornutine  in  ergot.  It  is  an  alkaloid, 
amorphous,  little  soluble  in  water,  but  the  salts  easily  soluble. 
Kobert  and  Lewitzky  attribute  to  cornutine  the  specific  action  of 
ergot  on  the  uterus.  By  irritating  the  uterine  center  in  the  lumbar 
cord  it  evokes  arrhythmic  contractions  of  that  organ.  In  non-preg- 
nant animals  these  contractions  only  occur  in  late  stages  of  poison- 
ing by  cornutine,  but  in  pregnant  animals  the  uterus  is  first  affected. 
The  pains  are  more  violent  the  nearer  the  animal  is>  to  full  term. 
Tetanoid  contraction  of  the  uterus  was  not  observed,  even  after 
large  doses. 

Toxic  doses  cause  convulsions,  by  centric  irritation.  Small  doses 
increase  the  reflex  excitability  of  the  cord,  while  large  doses  paralyze 
it.  Very  small  doses  slow  the  pulse  by  irritating  the  pneumogastric, 
and  very  large  doses  paralyze  it.  The  blood-pressure  is  vastly  in- 
creased. This  is  followed  after  large  doses  by  paralysis  of  the  vaso- 
motor  center  and  a  corresponding  fall  of  the  pressure.  The  striated 
muscles  are  also  affected  causing  stiffness*  similar  to  that  caused  by 
veratrine.  Lethal  doses  cause  death  by  paralyzing  the  respiratory 
center.  Both  stomach  and  bowel  contract  powerfully  under  cornu- 
tine. 

Another  body  was  discovered  by  Kobert  in  ergot,  to  which  he 
gave  the  name  of  sphacelinic  acid.  This  produces  gangrene;  and 
one  of  the  advantages  of  employing  cornutine  is  that  this  acid  is 
thereby  left  out. 

Lewitzky  says  cornutine  is  the  surest  means  of  exciting  uterine 
contractions,  whether  the  organ  is  pregnant,  or  enlarged  from 
chronic  metritis,  or  after  abortion.  The  indications  are  therefore 
the  same  as  for  ergot. 

Meisels  used  cornutine  successfully  for  urethral  and  vesical 
hemorrhage  in  paretic  spermatorrhea.  The  citrate  is  preferred. 
Dose,  gr.  1-33  to  1-6.  It  is  not  well  suited  for  hypodermic  adminis- 
tration. Cornutine  keeps  better  than  other  ergot  derivatives,  espe- 
cially when  kept  dry.  The  price  is  as  yet  too  high  for  extensive  use 
— a  dollar  a  grain  is  Merck's  price. 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


CORNUTINE  181 

Until  the  cost  is  within  reason  the  best  preparation  of  ergot  ac- 
cessible is  Bonjean's  ergotin,  a  watery  extract.  When  prepared  by 
the  best  makers  this  is  fairly  uniform  and  active.  It  has  the  very 
great  advantage  of  being  readily  used  hypodermically. 

Acute  poisoning  by  ergot  has  been  noted  after  attempts  to  secure 
abortion.  The  symptoms  are  collapse,  weak,  rapid  pulse,  tingling, 
itching  and  coldness  of  the  skin,  unquenchable  thirst,  vomiting  and 
diarrhea,  confusion  or  unconsciousness,  uterine  hemorrhages,  abor- 
tion and  jaundice.  Subcutaneous  and  internal  ecchymoses  were 
found  (Cushny). 

Chronic  poisoning  from  the  use  of  ergotic  rye  is  still  seen  in 
Russia.  The  symptoms  fall  into  two  groups,  the  gangrenous  and 
the  nervous. 

The  gangrene  occurs  in  the  fingers  and  toes,  extending  along  the 
entire  limb,  which  is  cold,  anesthetic,  dusky,  then  dry,  hard  and 
shrunken,  falling  off  with  slight  pain  and  no  hemorrhage.  In  mild 
cases  only  the  skin  is  affected.  Internal  necrosis  may  occur,  caus- 
ing cataract,  ulcers  of  the  bowel,  stomach,  lung  or  uterus.  Abortion 
is  uncommon. 

In  the  neurotic  form  there  are  depression,  weakness,  drowsiness, 
headache,  giddiness  and  paresthesiae.  Paroxysmal  convulsion?  oc- 
cur, clonic,  epileptiform,  followed  by  contractures  of  the  limbs, 
sometimes  of  the  trunk.  Mental  debility  even  to  dementia  may 
ensue. 

The  accounts  given  of  the  action  of  ergot,  therapeutic  and  toxic, 
are  so  contradictory  that  little  value  is  to  be  attributed  to  them.  It 
is  evident  that  the  various  preparations  of  this  drug  vary  greatly  as 
to  the  nature  and  proportions  of  their  active  constituents.  No 
definite  effect  is  to  be  expected  from  such  uncertain  agents.  For 
instance,  many  observers  credit  ergot  with  the  power  of  causing 
uterine  contractions  and  an  equal  number  deny  that  it  can  initiate 
these  movements.  Most  physicians  believe  that  it  causes  tetanic 
contractions  of  the  uterus  after  parturition  ha&  commenced,  but 
others  deny  this.  It  would  seem  that  an  agent  so  uncertain  had  bet- 
ter be  left  out  of  practice ;  but  since  the  desired  effect  can  surely  be 
obtained  from  cornutine,  there  is  no  reason  we  should  deny  our- 
selves of  its  great  benefits. 

Ergot  has  been  applied  locally  for  gonorrhea,  acne,  rosacea,  con- 
junctivitis, endocervicitis',  and  incipient  boils  (Shoemaker)  ;  also  for 
hemorrhoids,  prolapsed  rectum,  relaxed  sphincter  ani  or  vesicae; 
but  there  seems  much  doubt  as  to  whether  an  agent  acting 


182  CORNUTINE 

upon  the  centers  as  ergot  does,  can  exert  any  local  action  beyond 
suggestion.  T.  Clemens  gave  ergotin  by  the  stomach  and  injected 
into  the  bladder  (4  grains  to  the  ounce)  for  ammoniacal  cystitis  of 
paraplegics,  with  advantage. 

Every  variety  of  hemorrhage  has  been  stopped  by  ergot  in  suf- 
ficient doses,  though  Binz  denies  its  efficacy  except  in  uterine  hemor- 
rhages. In  these  it  has  been  the  writer's  experience  to  find  the 
bleeding  reduced  by  ergot  to  a  mere  dribble,  but  this  refused  to  stop 
even  when  the  drug  was  given  till  the  legs  grew  cold  and  the  pulses 
at  the  ankle  were  imperceptible.  But  when  digitalin  was  then  given 
the  remaining  hemorrhage  ceased.  This  was  in  postpartum  bleed- 
ing. When  the  hemorrhage  is  from  uterine  tumors,  polypi  or 
fibromyomas,  there  is  evidence  that  ergotin  checks  the  bleeding  and 
reduces  the  growth  by  cutting  off  its  blood  supply  and  constringing 
the  uterus.  Mechanical  means  may  be  employed  to  facilitate  the 
separation  and  extrusion  of  the  tumors. 

In  labor  when  there  is  a  history  of  previous  floodings,  it  is  cus- 
tomary to  give  a  full  dose  just  as  the  child's  head  is  ready  to  be 
born — presses  upon  the  perineum,  the  latter  dilated  properly. 

In  uterine  subinvolution  Hirst  recommends  ergot  with  strych- 
nine and  quinine. 

Night  sweats,  hyperidrosis,  galactorrhea,  have  been  treated  by 
ergot.  In  purpura  it  is  usually  given,  but  the  writer  has  never  wit- 
nessed any  good  effect  from  it.  In  relaxed  states,  as  in  diarrheas, 
dysenteries,  passive  pulmonary  congestions,  etc.,  ergot  may  be  of 
value  but  strychnine  fills  this  indication  so  well  that  nothing  else 
is  needed. 

In  diabetes-  insipidus  the  outflow  of  urine  is  controlled  to  some 
extent  by  full  doses  of  ergotin,  and  it  has  been  used  in  glycosuria 
also.  The  powerful  vasoconstrictor  effect  of  ergotin  has  been 
utilized  in  treating  congestive  dysmenorrhea  and  migraine,  spinal 
hyperemia,  vesical  paralysis,  whooping-cough,  etc.  It  has  been  in- 
jected hypodermically  for  varicose  veins,  varicocele,  enlarged  spleen, 
and  hemorrhoids.  In  acne  when  enough  ergotin  is  given,  the 
malady  completely  disappears,  but  returns  when  the  ergot  effect 
passes  off. 

In  many  affections  of  the  nervous  centers,  brain  and  cord,  ergot 
in  full  doses  has  been  advised,  such  as  spinal  hyperemias,  paraplegia, 
chronic  mania  with  hyperemia,  in  fact  in  any  hyperemic  malady  of 
these  tissues. 


CORYDALIN  188 

Paretic  spermatorrhea  is  said  to  have  been  benefited  by  this 
drug. 

Gossypiin,  hydrastine,  physostigmine  and  pilocarpine  cause 
uterine  contractions  and  are  synergists  of  ergotin  in  that  respect. 

Digitalin,  hydrastine,  hydrastinine,  are  synergistic  as  hemostatics. 

Ergotin  has  been  given  to  restrain  too  free  mucous  discharges, 
leucorrhea,  etc.  It  has  been  injected  hypodermically  over  aneurisms 
with  benefit.  In  a  case  of  pulsation  of  the  abdominal  aorta  where 
ergotin  was  employed  under  the  mistaken  diagnosis  of  aneurism, 
recovery  ensued. 

The  dose  of  ergotin  by  the  mouth  is*  gr.  1-6  to  j,  repeated  every 
hour  or  less,  as  needed.  In  acute  hemorrhages  or  to  stimulate  the 
uterus  it  may  be  given  hypodermically  in  single  doses  of  three  grains 
every  four  to  eight  hours.  In  nervous  maladies  Wood  gave  fluid 
extract  of  ergot  in  doses*  of  a  dram  to  an  ounce ;  but  this  preparation 
is  so  uncertain  that  little  definite  information  as  to  dosage  is  to  be 
derived  from  it. 

The  effects  of  ergot  are  not  manifest  for  some  hours  after  ad- 
ministration. 

CORYDALIN. 

Standard  granule — Gr.  1-6,  gm.  .01. 

Corydalin  is  a  concentration  from  the  tubers  of  Corydali^ 
formosa,  the  turkey  corn.  The  plant  contains  an  alkaloid,  coryda- 
line,  discovered  by  Wenzell.  It  is  insoluble  in  water,  soluble  in 
ether  easily,  with  difficulty  in  alcohol,  Merck  describes  three  alka- 
loids found  in  this  plant.  By  the  eclectics  corydalis  is  accredited 
with  tonic,  diuretic  and  alterative  properties.  It  was  employed  as  a 
remedy  for  syphilis  but  except  as  a  tonic  is  not  thought  to  possess 
any  value  (King).  When  syphilis  is  constitutional,  in  debilitated 
subjects,  corydalis  possesses  an  efficacy  unequalled  as  an  alterative 
tonic  (King).  Recent  syphilitic  nodes,  especially  on  the  skull,  are 
chiefly  influenced  by  it.  It  promptly  relieves  the  shin  pains.  Locke 
recommends  it  in  atonic,  scrofulous  and  syphilitic  cases  of  amenor- 
rhea,  dysmenorrhea  and  leucorrhea;  also  as  a  digestive  tonic  in 
atonic  abdominal  enlargement,  dysentery  and  diarrhea  with  coated 
tongue,  fetid  breath  and  poor  digestion.  It  is  useful  in  malarial 
cachexia. 

Specific  Indications.— Syphilitic  or  scrofulous  diathesis;  yellow 
skin  with  lymphatic  enlargements ;  syphilitic  nodes ;  increases  waste 
and  improves  nutrition. 


184  COTOIN 

Ellingwood  says  overdoses  cause  biliousness,  deranged  stomach, 
excessive  secretion  of  mucus,  gastrointestinal  catarrh,  anorexia,  in- 
digestion, fetid  breath,  irregular  bowels,  colic,  and  malaise.  In 
remedial  doses  it  is  a  tonic,  increasing  vitality  and  influencing  meta- 
bolism; cooperating  with  echinacea,  berberis,  hydrastis,  xanthox- 
ylum  and  stillingia.  In  chronic  skin  diseases  with  marked  cachexia 
it  is  speedily  curative;  superior  if  there  is  relaxation  of  tissue  and 
plethora. 

The  dose  of  corydalin  is  a  grain  four  times  a  day  in  chronic 
conditions. 

COTOIN. 

Standard  granule — Gr.  1-67,  gm.  .001. 

Cotoin  is  a  glucoside  derived  from  the  bark  of  an  undetermined 
South  American  tree.  It  is  soluble  in  alcohol  or  ether,  or  in  boiling 
water,  almost  insoluble  in  cold  water.  Watery  solutions  of  alkalies 
or  of  their  carbonates  dissolve  it. 

Goto  has  the  properties*  of  a  bitter  tonic  and  of  an  astringent.  It 
has  been  used  as  a  remedy  for  various  forms  of  diarrhea  with  suc- 
cess. Burkhart  and  Rieker  attributed  to  it  extraordinary  efficacy  in 
enteritis,  diarrhea,  dysentery,  etc.  In  cholera  infantum  it  acts  as 
other  astringents  do.  In  phthisis  it  is  more  effective,  and  also  re- 
strains the  colliquative  sweats.  Engel  asserted  that  it  had  a  selec- 
tive action  in  tubercular  diarrhea,  so  that  any  diarrhea  checked  by 
coto  might  thereby  be  diagnosed  as  tubercular.  Cotoin  is  especially 
useful  where  opiates  are  contraindicated. 

Large  doses  of  coto  cause  a  sense  of  warmth  in  the  stomach,  and 
larger  ones  give  rise  to  nausea  and  vomiting.  The  saliva  is  in- 
creased. It  retards-  the  development  of  bacteria,  and  of  putrefaction. 
It  actively  dilates  the  intestinal  vessels.  In  healthy  persons  it  does 
not  constipate.  Shoemaker  pronounces  coto  remarkably  efficient  in 
all  forms  of  diarrhea  except  that  with  intestinal  ulcers. 

Albertoni  reported  no  success  in  drunkards  or  when  the  portal 
circulation  was  obstructed,  as  in  cirrhosis.  Enteric  hyperemia  and 
tendency  to  intestinal  hemorrhage  contraindicate  coto.  In  acute  in- 
testinal catarrhs  it  should  therefore  be  used  with  care. 

The  dose  of  cotoin  is  gr.  1-67  to  1-22  every  two  hours. 

Coto  is  singularly  repugnant  to  the  stomach,  and  few  patients 
will  take  it  long,  the  aversion  becoming  insurmountable  (Huese- 
mann). 


CREASOTE  186 

Cotoin  does  not  interfere  with  the  action  of  pepsin  or  of  ptyalin. 
It  is  excreted  by  the  kidneys  and  diminishes  the  excretion  of  indican. 
Insoluble  in  the  gastric  juice  it  passes  unaltered  into  the  intestine. 
The  intestine,  says  Albertoni,  is  the  habitat  par  excellence  of  the 
putrefactive  process.  Here  we  encounter  nearly  all  the  products  of 
the  putrid  fermentation,  peptones,  tyrosine,  leucine,  organic  acids, 
phenol,  indol,  scatol,  ammonia,  carbonic  acid,  stilphydric  acid,  hydro- 
gen, hydrogen  protocarbonate.  The  majority  of  these  are  reab- 
sorbed,  and  traces  of  phenol  are  found  in  the  stools,  most  of  it  in 
the  urine.  The  indican  of  the  urine  is  derived  from  the  indol.  The 
quantity  of  indican  found  in  the  urine  shows  the  intensity  of  the 
putrefactive  process  in  the  bowel.  Albertoni  found  that  phenol  con- 
tinued to  be  found  in  the  urine  despite  the  use  of  cotoin.  The  de- 
crease of  indican  observed  by  Burkart  and  Pribram  under  cotoin 
must  be  attributed  to  a  secondary  effect,  consecutive  to  the  ameliora- 
tion of  the  intestinal  malady.  By  determining  active  dilation  of  the 
intestinal  vessels  cotoin  improves  the  nutrition  of  the  mucosa  and 
increases  its  faculty  of  absorption. 

It  follows  that  the  indication  for  cotoin  in  diarrheas  is  asthenia, 
the  atonic  or  relaxed  condition.  Van  Renterghem  found  this  agent 
useful  for  aged  patients.  In  children  the  diarrhea  of  rickets  is  espe- 
cially amenable  to  cotoin.  Much  larger  doses  than  those  above 
given  may  be  used.  Albertoni  gave  gr.  1-6  to  a  newborn  infant  with 
impunity.  Van  Renterghem  gave  to  an  adult  ten  grains  within  24 
hours-. 

CREASOTE. 

Standard  granule — Gr.   1-67. 

Despite  the  differences  of  opinion  regarding  the  usefulness  of 
creasote  in  phthisis  it  will  continue  to  be  given  in  this  disease  until 
something  else  has  proved  more  efficacious.  It  is  a  powerful  anti- 
septic resembling  carbolic  acid  greatly  in  its  effect  but  is  markedly 
less  injurious  to  the  human  tissues.  It  is  eliminated  through  the 
lungs  and  bronchial  mucosa  and  though  it  cannot  possibly  destroy 
the  bacilli  in  the  lesion  it  probably  renders  them  weaker  and  cer- 
tainly renders  the  parts  a  less  suitable  field  for  their  propagation. 
It  also  disinfects  the  sputum  and  this  is  of  no  small  moment  for  to 
render  the  discharges  of  the  phthisical  patient  less  dangerous  to 
himself  and  others  is  to  accomplish  a  good  deal.  The  consumptive 
often  reinfects  himself.  This  is  unquestionable.  The  drug  is  also 
eliminated  through  the  kidneys  and  this  has  lead  to  its  use  in 


186  CROTON  OIL 

diabetes  and  Bright's  disease.  While  it  is  impossible  to  term  it  a 
remedy  for  these  conditions  some  cases  have  improved  upon  it. 
Creasote  destroys  germs  with  which  it  come  in  contact  and  thus  is 
of  use  in  stomachic  and  intestinal  fermentative  conditions.  It  is 
also  an  excellent  anti-nauseant.  It  can  be  given  combined  with  bis- 
muth in  all  forms  of  nausea  with  success. 

The  dose  in  phthisis  should  be  large.  Three  to  six  granules 
may  be  given  every  three  hours.  An  excellent  plan  is  to  begin  with 
two  and  gradually  increase  as  the  patient  becomes  tolerant.  Some 
subjects  can  take  enormous  doses  and  thrive  upon  them.  The  secret 
of  success  with  this  remedy  in  pulmonary  phthisis  is  "dose 
enough."  In  purulent  pneumonitis  creasote  will  prove  invaluable. 
Two  to  four  granules  may  be  given  with  some  nutrient  every  three 
hours.  In  bronchitis  and  bronchorrhea  it  corrects  the  offensive  dis- 
charges and  certainly  aids  in  obtaining  a  cure.  In  such  cases  as  are 
suited  to  this  remedy,  cough  lessens,  sputum  diminishes,  night 
sweats  cease  and  diarrhea  (if  present)  stops.  Vomiting  is  con- 
trolled, the  gastric  irritability  lessens  and  the  patient  shows  general 
improvement.  Creasote  should  be  given  either  with  food  or  with  a 
diluent.  It  is  a  useful  and  dependable  remedy  and  should  be  in 
every  doctor's  case. 

CROTON   OIL. 

Croton  oil  may  be  separated  by  alcohol  into  two  portions,  that 
soluble  in  alcohol  being  irritant,  the  residue  purgative.  The  former 
depends  on  crotonolic  acid  for  its  effects. 

Applied  to  the  skin  croton  oil  causes  a  pustular  inflammation  or 
eruption,  sometimes  leaving  scars.  The  vapor  may  cause  inflamma- 
tion of  the  conjunctivae,  nose  and  air-passages'.  Burning  follows 
its  local  application  in  five  minutes.  The  pustules  dry  up  and  disap- 
pear in  a  few  days.  Sometimes  the  oil  is  absorbed  and  causes  purg- 
ing, even  through  the  unbroken  skin.  Applied  to  wounds  or  de- 
nuded surfaces  it  causes'  phlegmonous  inflammation,  with  suppura- 
tion. 

Taken  internally  in  doses  of  a  drop,  croton  oil  causes  burning 
and  irritation  of  the  mucous  surfaces  with  which  it  comes  in  con- 
tact. Within  two  hours  abdominal  rumbling  and  pains  begin,  with 
watery  stools  that  irritate  the  anal  tissues.  Larger  doses  cause 
symptoms  resembling  cholera  morbus,  violent  vomiting,  aching  in 
the  muscles  and  joints,  cyanosis,  fall  in  temperature  and  death. 


THERAPEUTIC   NOTES 


THERAPEUTIC    NOTES 


CUBEBIN  187 

Three  drops  may  cause  violent  gastroenteritis.  Five  drops'  caused 
death. 

Croton  oil  is  given  as  a  derivative  in  congestions  of  the  brain  or 
spinal  cord,  threatened  apoplexy,  etc.,  and  eclampsia,  where  there  is 
need  of  prompt  arid  powerful  effect.  In  obstipation  and  intestinal 
obstructions  it  is  a  very  dangerous  drug,  and  does  infinitely  more 
harm  than  good. 

The  average  purgative  dose  is*  one  drop.  Some  believe  that 
croton  oil  in  smaller  doses  acts  mildly,  like  castor  oil ;  and  it  has 
been  given  in  pills  of  soap  containing  each  one-tenth  of  a  drop  of 
croton  oil  with  asserted  benefit.  The  oil  from  which  the  acridity 
had  been  abstracted  by  alcohol  might  be  thus  used,  and  possibly  we 
could  thus  obtain  in  a  granule  or  tablet  the  virtues  of  the  bulky  and 
disagreeable  but  valuable  castor  oil. 

There  is  a  popular  belief  that  croton  oil  in  huge  doses  will  cure 
the  alcohol  habit ;  and  the  writer  has  been  asked  to  prescribe  it  in 
doses  of  a  dram.  In  one  case  a  woman  administered  to  her  husband 
half  a  dram  each  of  croton  oil  and  oil  of  black  pepper  at  a  single 
dose.  It  did  not  quite  kill  the  patient,  though  perilously  near  it; 
and  accomplished  a  cure.  In  another  case  a  consumptive  took  a 
similar  dose  by  mistake  and  recovered.  In  these  cases  it  is  probable 
that  the  oil  was  not  of  full  strength. 

Locally  the  oil  is  applied  for  any  of  the  purposes  for  which  a 
counterirritant  may  be  used.  The  promptness  of  its  action  recom- 
mends it ;  but  the  effect  lasts  so  long  and  the  occasional  occurrence 
of  absorption  and  purgation  have  made  this  application  less  popular 
than  of  old.  If  diluted  with  three  times*  its  bulk  of  any  bland  oil 
like  sweet  almond  oil,  the  effect  is  pleasanter  and  more  under  con- 
trol. A  few  drops  rubbed  in  over  the  sacrosciatic  notch  is  decidedly 
beneficial  in  sciatica. 

In  ringworm  this  oil  has  been  applied  as  a  substitution  method, 
but  modern  methods  are  better.  When  given  as  a  purgative  it  is 
well  to  employ  castor  or  sweet  oil  as  a  vehicle. 


CUBEBIN. 

Standard  granule— Gr.  1-67.  gm.  .001. 

Cubebin,  the  resinous  principle  from  the  unripe  berries  of  Piper 
cubeba,  is  a  stimulant  stomachic  carminative  and  expectorant.  The 
fluid  preparations  contain  a  volatile  oil,  a  fixed  oil  and  cubebic  acid 


188  CURARINE 

which  make  them  somewhat  more  irritating  to  the  intestinal  tract 
than  is  cubebin. 

Its  chief  use  is  in  disorders  of  the  urinary  passages.  In  gonor- 
rhea and  gleet  its  action  is  well  known.  It  acts  as  a  sedative  to  the 
mucous  coat  and  seems  to  allay  irritability.  The  standard  granule 
contains  gr.  1-67,  and  one,  two  or  three  may  be  exhibited  every 
hour. 

As/  an  expectorant  one  every  two  hours  often  gives  good  results. 
Scillitin  may  be  given  in  conjunction  and  cubebin  and  codeine,  one 
granule  of  each,  has  relieved  some  markedly  stubborn  cases  of 
bronchial  asthma.  In  arresting  the  discharge  following  acute 
prostatitis  cubebin  is  useful  and  it  has  been  recommended  as  a  rem- 
edy for  spermatorrhea.  In  catarrhs  of  the  bladder  it  is  of  un- 
doubted value ;  indeed,  it  is  here  that  its  chief  field  exists.  It  should 
not  be  forgotten  that  large  doses  sometimes  cause  a  marked  fever- 
ish condition  with  some  erythema. 


CURARINE. 

From  the  Indians  of  the  Orinoco  is  obtained  an  arrow  poison 
known  as  curare.  Three  kinds  come  to  the  market,  that  which  is 
brought  in  tubes  of  bamboo,  in  calabashes,  and  in  little  clay  pots. 
These  are  different  in  their  effects  and  strength.  Five  alkaloids 
have  been  found  in  these,  the  most  important  being  curarine. 

This  is  a  bright  reddish-yellow  amorphous  mass,  that  from  tube 
curare  being  quite  stable,  soluble  in  water  or  in  alcohol. 

Curarine  given  in  large  doses  hypodermically,  paralyzes  the 
striated  muscles,  beginning  with  the  short  ones,  the  ears,  toes  and 
neck,  then  those  of  the  extremities  and  finally  the  respiratory  ap- 
paratus* which  gradually  comes  to  a  stop.  The  heart  continues  beat- 
ing a  while  longer  and  then  also  stops.  Small  doses  weaken  the 
voluntary  muscles  alone,  the  respiration  becoming  labored  but  do 
not  affect  the  heart. 

The  rationale  of  this  action  is  disputed,  though  it  evidently  takes 
place  through  the  blood.  The  ends  of  the  motor  nerves  are  par- 
alyzed, but  neither  the  trunks  nor  the  centers.  The  metabolism  as 
represented  by  the  exchange  of  gases  is  markedly  lessened,  from  the 
muscular  relaxation.  To  this  is  also  due  the  fall  in  temperature. 

The  earlier  experiments  with  curare  are  inaccurate  from  the 
varying  nature  of  the  specimens,  but  Tillie  employed  pure  curarine 


CURARINE  189 

and  his  results  are  of  value.  He  found  that  small  doses  abolish  the 
posterior  reflexes,  by  cerebral  inhibition.  Large  doses  affect  the 
spinal  cord  directly,  increasing  irritability  and  causing  convulsions, 
increasing  to  tetanic  severity.  This  follows  only  direct  application 
of  the  drug  to  the  cord. 

When  curare  slows  the  heart,  reduces  the  arterial  pressure  and 
arrests  the  heart  in  diastole,  it  is  due  to  the  other  alkaloid,  curine, 
not  to  curarine.  To  which  principle  is  to  be  ascribed  the  lachryma- 
tion,  polyuria  and  salivation  following  some  curares,  is  uncertain. 
The  skin  is  at  first  dry,  followed  by  an  outburst  of  perspiration,  dry- 
ness  of  the  mouth  and  burning  thirst.  The  temperature  rises  nearly 
two  degrees. 

Chattering  of  the  teeth,  shivering  and  trembling  precede  the 
pareses. 

Taken  by  the  mouth,  curarine  has  little  if  any  effect,  even  in 
very  large  doses.  Either  it  is  destroyed  by  the  gastric  juice  or  the 
absorption  does  not  more  than  keep  pace  with  the  elimination. 

Curarine  has  been  employed  in  affections  characterized  by  exces- 
sive irritability  of  the  motor  terminal  nerves,  such  as  tetanus  and 
hydrophobia.  Two  cases  of  the  latter  have  been  reported  as  cured 
by  this  remedy.  The  great  difficulty  in  obtaining  it  in  purity,  and 
the  variable  effects  manifested  by  the  curares  sent  to  market,  have 
prevented  its  general  employment  in  affections  of  such  gravity. 
Cushny  considers  curare  not  indicated  in  these  maladies,  which  de- 
pend on  centric  irritations,  while  the  drug  acts  only  on  the  nerve- 
ends.  But  Murrell  speaks  highly  of  the  use  of  methyl-iodine-strych- 
nine, whose  effects  are  identical  with  those  of  curarine,  and  which 
may  be  prepared  in  uniform  strength  and  purity  sufficient  to  justify 
its  employment.  In  paralysis  agitans,  chorea,  and  a  number  of 
similar  maladies-  this  agent  should  prove  of  decided  value. 

Curarine  seems  to  be  excreted  unchanged  by  the  kidneys.  It  has 
been  given  in  epilepsy  with  asserted  advantage.  The  dose  to  begin 
with  is  gr.  1-250,  hypodermically,  increasing  till  effect.  In  hydro- 
phobia Offenberg  gave  gr.  1-2  to  a  woman  and  saved  her.  In 
strychnine  poisoning  curare  has  been  used  with  success.  Here  it 
seems  to  be  a  rational  antidote.  In  tetanus  Hoffman  gave  curarine 
gr.  1-67.  increasing  to  9-67,  hypodermically.  A  case  of  tetany  is 
reported  in  which  doses  of  gr.  7-67  proved  effective. 

Curarine  may  be  administered  by  the  rectum,  in  doses  some- 
what larger  than  by  hypodermic. 


190  CYPRIPEDIN 

CYPEIPEDIN. 

Standard  granule — Gr.  1-12,  gm.  .oo.s. 

Cypripedin  is  a  concentration  from  Cypripedium  pubescens,  the 
ladies'  slipper.  No  active  principle  has  been  found  in  this  plant. 

Scudder  terms  cypripedium  tonic,  stimulant,  diaphoretic  and 
antispasmodic.  Its  chief  value  is  as  a  nerve  stimulant  in  atonic 
cases,  improving  the  circulation  and  nutrition  of  the  nerve  centers. 
Felter  and  Lloyd  enumerate  as  its  uses,  allaying  nervous  excitability 
or  irritation  unconnected  with  organic  lesions,  lessening  pain,  pro- 
ducing a  calm  and  cheerful  state  of  mind  and  thus  favoring  sleep ; 
hysteria,  chorea,  nervous  headache,  wakefulness,  prostration  in  low 
fevers,  epilepsy,  all  morbid  irritabilities  of  the  nervous  system  from 
non-organic  causes ;  nervousness,  hypochondria  and  mental  depres- 
sion of  deranged  digestion,  especially  in  females ;  joint  pains  fol- 
lowing scarlet  fever. 

Specific  Indications. — Insomnia,  nervous  irritability,  neuralgia, 
delirium,  all  from  atony ;  menstrual  irregularities  with  despondency ; 
tendency  to  dementia  at  climacteric;  mental  depression  from  self- 
abuse. 

Ellingwood  says  the  virtues  of  this  plant  are  lost  by  drying,  and 
only  fresh  root  preparations  should  be  employed.  Large  doses  are 
requisite.  He  advises  it  in  nervous  conditions  from  genitourinary 
disorders;  mental  depression  from  sexual  causes;  it  allays  cerebral 
irritation  from  teething;  typhoid  vigilance  and  jactitation  with  vital 
depression,  and  that  from  dyspepsia. 

These  quotations  show  the  place  of  cypripedin  to  be  close  to  that 
formerly  filled  by  valerian.  Neither  is  a  powerful  remedy,  but  for 
them  there  is  a  large  class  of  cases  that  do  not  require  a  very  strong 
remedy.  It  is  the  little  ailments  that  wear  out  the  endurance,  as 
bankruptcy  is  more  easily  borne  than  the  continual  nagging  of  a 
nervous,  fretful  wife.  Cypripedin  relieves  the  minor  ailments  that 
cause  nervousness,  and  leaves  a  sense  of  comfort  and  well-being, 
somewhat  resembling  the  euphoria  of  morphine.  Possibly  cypri- 
pedin may  prove  of  value  in  treating  the  withdrawal  symptoms  of 
this  and  other  habit  drugs. 

The  writer  has  employed  cypripedin  largely  to  relieve  sexual 
erethism,  with  satisfaction.  It  soothes  the  sexual  organs  and  quiets 
the  irritability  that  leads  to  the  exhaustion  of  the  forces  by  constant 
discharges  of  energy.  The  patient  must  be  warned  that  the  effect 
will  be  a  lessening  of  sexual  desire,  or  else  he  will  think  it  is  de- 


DIASTASE  ii»i 

priving  him  of  his  powers.  Explain  that  the  energy  is  simply  stored 
up  by  cypripedin  instead  of  being  uselessly  discharged,  and  he  will 
be  satisfied.  This  result  has  followed  the  use  of  cypripedin  in  both 
sexes. 

The  dose  most  effective  has  been  a  grain  four  times  a  day,  and 
the  drug  should  be  continued  for  a  month.  It  is  often  wise  to  give 
cypripedin  for  a  month  and  then  follow  with  cornin  for  a  similar 
period. 

Cypripedin  is  one  of  the  remedies  lost  to  the  old  therapist  by  the 
uselessness  of  the  preparations  in  the  shops.  While  a  freshly-made 
infusion  probably  excels,  the  writer  has  found  cypripedin  quite 
active. 


DIASTASE. 

Standard  granule — Gr.  1-6,  gm.  .01. 

This  substance  is  an  enzyme,  a  name  used  in  organic  chemistry 
to  designate  unformed  ferments  as  distinguished  from  organized 
ferments. 

Diastase  is  obtained  from  barley  and  other  cereals  when  in 
process  of  germination.  It  is  a  saccharifying  or  amylolytic  ferment, 
which  has  the  power  of  slowly  converting  starch  into  grape  sugar, 
with  the  intermediate  body  maltose.  To  the  saccharifying  enzymes 
belong  this  body,  diastase,  ptyalin,  and  the  diastasic  ferments  of  the 
pancreas,  liver,  blood,  mucosa,  of  the  trachea,  and  gall-bladder, 
spleen,  skin,  kidneys,  testicles,  lungs,  lymphatic  glands  and  muscles. 

In  the  vegetable  kingdom  these  saccharifying  enzymes  are  very 
abundant,  as  in  the  buds  of  leaves  and  in  germinating  seeds ;  espe- 
cially of  the  cereals  and  legumes.  There  is  also  an  enzyme  derived 
from  the  bacterial  fungus  of  rice,  Aspergillus  eurotium  6ryzae, 
called  after  its  Japanese  discoverer  Takamine,  Taka  diastase. 

Diastase  may  be  found  in  small  quantities  in  malt  extracts,  when 
care  is  taken  not  to  disperse  this  substance  by  the  heat  employed  in 
making  the  extract.  Whether  the  animal  diastases  are  identical 
with  those  of  vegetable  origin  is  yet  a  question.  But  assuming  that 
ptyalin,  the  diastasic  enzyme  of  the  saliva,  is  at  least  very  nearly 
identical  with  vegetable  diastase,  and  remembering  too  that 
omnivora  and  carnivora  produce  ptyalin  but  very  little  or  not  at  all, 
while  herbivora  produce  it  abundantly  in  their  saliva,  we  come  to 
the  reasonable  conclusion  that  diastase  must  be  useful  in  amylaceous 
indigestion ;  and  so  it  is  found  in  practice. 


192  DIASTASE 

CiiS'hny  doubts  the  existence  of  such  an  indigestion.  In  his 
Pharmacology,  page  688,  he  says :  "Taka-diastase,  which  digests 
over  loo  times  its  weight  of  starch,  has  been  recommended  in  cases 
in  which  there  is  supposed  to  be  a  deficient  digestion  of  starch.  It 
ceases  to  act  in  the  gastric  juice  as  soon  as  the  acidity  exceeds  o.i 
per  cent,  but  may  be  able  to  digest  a  certain  amount  of  starch  in  the 
mouth  and  stomach  before  it  is  destroyed.  The  question  at  once 
arises  however,  whether  the  ordinary  digestive  juices  are  ever  un- 
able to  digest  the  starch  of  the  food.  And  although  a  new  term, 
amylaceous  dyspepsia,  has  been  introduced  to  indicate  this  class  of 
cases,  if  they  should  be  found  to  exist,  it  must  be  admitted  that  no 
satisfactory  evidence  of  their  existence  has  been  brought  forward 
as  yet.  It  is  stated  that  more  starch  is  found  to  be  digested  in  the 
stomach  after  the  administration  of  diastase,  but  this  seems  to  be 
beside  the  point,  for  it  merely  indicates  that  less  starch  reaches  the 
intestine  for  the  pancreatic  juice  to  act  upon.  Until  it  is  shown  that 
in  some  cases  the  digestion  of  starch  by  the  intestinal  ferments  is 
insufficiently  performed,  the  diastase  preparations-  would  seem  to  be 
superfluous.  According  to  Friedenwald  diastase  increases  the 
digestion  of  starch  in  the  stomach  chiefly  in  cases  of  hyperacidity; 
but  doubt  is  thrown  upon  this  statement  by  the  investigator." 

Practice,  however,  does  not  sustain  this  skepticism.  We  do 
meet  with  cases  where  starchy  food  is  badly  digested  and  eructa- 
tions of  odorless  gas  follow  its  ingestion,  in  which  diastase  serves 
an  excellent  purpose.  Moreover,  diastase  hastens  the  natural 
amylolytic  or  saccharifying  process.  The  usefulness  of  diastase 
in  diabetes  mellitus,  especially  from  pancreatic  disturbances,  when 
the  withholding  of  bread  becomes  intolerable  and  it  must  be  al- 
lowed to  some  extent,  rests  upon  this  hastening  quality.  What 
exhausts  the  patient  here  is  the  protracted  slow  process  of  the  sac- 
charification  of  starch.  It  seems,  therefore,  that  when  this  process 
is  quickly  performed  and  the  sugar  gotten  rid  of  by  the  excretions, 
this  is  the  cause  of  the  patient's  comparative  relief,  and  this  gives 
him  a  better  chance  for  other  appropriate  treatment. 

Diastase  is  an  albuminous  body,  obtained  by  precipitation  from 
a  watery  malt  extract,  as  a  white  powder.  The  minimum  dose  is  gr. 
2,  and  reasonably  more  when  indicated. 

As  with  the  other  artificial  digestants,  the  effects  of  a  few  grains 
of  diastase  are  immensely  greater  than  those  attributable  to  its  own 
digestive  powers.  The  function  of  these  bodies  seems  to  be  to  set 
the  digestive  process  going.  The  secretion  of  the  natural  digestants 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


DIGITALIN  193 

elaborated  in  the  body  appears  to  be  regulated  automatically,  and' 
ceases  when  enough  has  been  provided  for  the  need.  But  sometimes 
the  secretion  is  not  begun,  and  food  may  be  vomited  hours  after  its 
ingestion,  without  any  sign  of  digestive  action.  Now  if  the  diges- 
tion is  begun  by  artificial  agents,  it  seems  that  the  process  once  set 
in  operation  is  continued  by  the  forces*  of  the  digestive  system,  until 
completed.  This  explanation  is  in  harmony  with  the  facts  observed 
clinically. 

Diastase  acts  only  upon,  the  carbohydrates,  and  only  during  the 
alkaline  period  of  digestion.  It  should  therefore  be  given  only  at 
the  beginning  of  the  meal,  and  with  starchy  food.  As  soon  as  the 
flow  of  gastric  acid  begins  the  action  of  diastase  ceases,  and  it  is 
exceedingly  doubtful  if  it  is  resumed  later  in  the  duodenum,  as  the 
diastase  is  itself  almost  certainly  digested  in  the  stomach.  Even 
when  clearly  indicated  the  use  of  diastase  should  not  lead  the 
physician  to  neglect  the  necessary  instructions  to  his  patient  as  to 
correct  eating.  If  people  thoroughly  masticated  and  insalivated 
carbohydrates  and  did  not  wash  their  food  down  with  fluids,  espe- 
cially iced  ones,  there  would  be  little  need  for  diastasic  aids. 

DIGITALIS. 

Standard  granule — Gr.  1-67,  gm.  .001. 

From  the  leaves  of  the  foxglove,  Digitalis  purpurea,  we  obtain 
the  greatest  of  the  cardiac  tonics.  The  leaves  contain  at  least  five 
glucosides,  known  as  digitin,  digitalin,  digitalein,  digitoxin  and 
digitonin.  Of  these  the  first  is  admitted  to  be  inert,  the  next  three 
resemble  each  other  in  their  effects  as  cardiac  and  vascular  tensors 
and  diuretics,  while  the  fifth  to  a  certain  extent  antagonizes  the 
actions  of  the  others.  These  active  principles  exist  in  the  plant  in 
varying  proportions.  The  strongest  digitalis  is  said  to  be  the  wild 
plant  of  England ;  that  found  in  Roumania  is  very  much  less  active, 
while  the  cultivated  herb  is  inert.  The  plant  is  a  perennial  and  only 
the  leaves  of  the  second  year's  growth  should  be  employed.  The 
leaves  are  only  active  within  a  year  from  the  time  they  are  gathered. 
Whether  the  irresponsible  herb  collector  cares  for  such  nicety,  or  if 
he  collects  the  wild  plant  when  it  is  so  easy  to  cultivate,  are  ques- 
tions for  those  who  adhere  to  the  use  of  galenics — the  alkalometrist 
demands  something  more  definite  and  sure. 

Pure  digitalin  is  a  white  amorphous  powder,  formula  C2n  H38 
O12.  It  dissolves  with  difficulty  in  water,  easily  in  alcohol  or  chloro- 
form. The  solution  is  very  bitter.  It  is  precipitated  by  tannic  acid. 


194  DIGITALIN 

Physiologic  and  Toxic  Actions. — A  lethal  dose  of  digitalin  par- 
alyzes the  heart,  arresting  it  in  diastole.  The  pulse  is  first 
slowed,  the  arterial  tension  increased.  The  pulse  is  then  accelerated, 
the  blood  pressure  falling  slowly  and  progressively,  interrupted  by 
brief  elevations.  The  heart-action  becomes  very  irregular,  pulse- 
rate  variable,  arterial  pressure  continually  falling;  finally,  sudden 
heart  paralysis  and  arrest  in  diastole. 

Traube  describes  three  stages :  The  arterial  pressure  rises  and 
the  pulse  slows ;  the  pulse-rate  rises  suddenly  to  its  maximum,  as  in 
atropine  poisoning,  the  arterial  pressure  rising  at  the  same  time, 
but  soon  beginning  to  sink  gradually  to  below  normal ;  the  pres- 
sure still  sinks,  the  pulse  again  slowing,  intermitting  and  irregular, 
the  beats  weaker,  finally  stopping  in  diastole. 

Small  doses  have  no  appreciable  effect  on  the  nerve  centers  of  a 
healthy  man.  They  sedate  the  nerves  and  favor  calm  and  sleep, 
when  there  is  agitation  and  insomnia  (Rabuteau). 

Toxic  doses,  or  even  smaller  ones  too  long  continued,  provoke 
vertigo,  headache,  obscurity  of  vision,  dilation  of  pupils,  ringing  of 
the  ears,  hallucinations,  muscular  weakness,  dulling  of  the  senses 
and  the  general  sensibility,  sometimes  convulsions1.  These  are  due 
to  the  circulatory  disturbance  and  the  increase  of  carbonic  acid  in 
the  blood. 

In  small  doses  digitalin  does  not  weaken  the  contractility  of  the 
voluntary  muscles  but  in  large  doses  it  extinguishes  it  rapidly. 
Small  doses  excite  the  contractility  of  smooth  muscle  fiber;  large 
doses  lessen  or  abolish  it. 

During  the  first  stage  the  thermometer  in  the  anus  shows  a  fall 
of  temperature,  while  at  the  surface  of  the  body  the  heat  is  aug- 
mented. This  is  explained  by  the  increase  of  the  arterial  pressure, 
the  acceleration  of  the  cutaneous  circulation,  and  the  radiation  of 
heat.  The  fall  of  temperature  in  the  following  stages,  and  in  fevers, 
is  explained  by  attributing  to  digitalin  the  power  of  removing  the 
causes  of  abnormal  hyperthermia,  or  of  indirectly  diminishing  the 
molecular  changes  and  the  production  of  heat,  by  slowing  the  cir- 
culation. 

Small  doses  of  digitalin  produce  no  notable  effect  on  the  gastro- 
intestinal tube  of  a  healthy  person.  Larger  ones  cause  nausea, 
anorexia,  vomiting,  gastric  disorder  and  diarrhea  (Koppe). 

Digitalin  is  not  a  true  diuretic,  and  has  no  value  as  a  renal  elim- 
inant  unless  the  defective  action  depends  on  heart-disease.  In 
healthy  persons  by  raising  the  arterial  pressure  it  lessens  or  sup- 


DIGITALIN  195 

presses  the  discharge  of  urine.  Sometimes  the  excretion  is  reestab- 
lished as  the  pressure  falls ;  in  others  it  only  returns  when  the  pres- 
sure has  become  subnormal.  Here  the  renal  vasomotors  seem  to  be 
affected  more  than  the  general  system.  After  these  arrests  the 
urine  is  always  albuminous.  But  other  elements  may  enter  to  ex- 
plain the  action  on  the  excretion  of  urine.  Increased  arterial  pres- 
sure may  check  it  by  mechanical  action. 

The  slowing  of  the  pulse  in  the  first  stage  is  attributed  by 
Traube  to  direct  excitation  of  the  centers  and  peripheric  intra- 
cardiac  ends  of  the  vagus.  Meyer  looks  on  the  slowing  as  secondary 
to  the  increased  vascular  pressure,  the  intracranial  tension  acting  on 
the  vagus  centers.  This  regulates  automatically  the  discharge  of 
blood  into  the  cranium.  But  Traube  found  that  cutting  the  cervical 
cord — which  lessens  arterial  pressure  universally — does  not  prevent 
the  slowing  of  the  pulse  by  digitalin.  Binz  does  not  consider  these 
views  antagonistic. 

How  digitalin  increases  the  blood-pressure  is  no  better  compre- 
hended. Binz  attributes  it  to  a  direct  action,  since  neither  atropine  nor 
section  of  the  inhibitory  nerves  prevents  it.  Traube  attributes  it  to  ex- 
citation of  the  cardiac  excitomotor  nerves.  But  as  on  the  excised  heart 
o,f  the  frog  digitalin  acts  precisely  as  on  the  heart  of  warm- 
blooded animals  in  situ,  there  seems  to  be  a  direct  relation  between 
the  drug  and  the  cardiac  muscular  fibers.  On  the  contrary,  Acher- 
mann  and  Kaufmann  consider  that  by  acting  on  the  vagus  centers  and 
peripheric  terminals,  it  augments  the  intravascular  pressure.  Binz 
says  the  arterial  pressure  depends  on  three  factors:  Increased 
energy  of  ventricular  contraction;  increased  frequency;  greater  re- 
sistance from  increased  systemic  vascular  tonicity. 

The  unquestioned  diuretic  property  of  digitalin  in  cardiac 
dropsies  is  thus  explained:  There  is  here  often  a  serous  transuda- 
tion  into  the  tissues,  due  to  the  enormous  passive  venous  hyperemia. 
Digitalin  regulates  the  abnormal  distribution  of  the  blood,  removes 
the  hyperemia,  and  permits  reabsorption  of  the  effused  serum.  The 
aqueous  blood,  and  the  general  increase  of  vascular  pressure,  espe- 
cially in  the  renal  arteries,  conduce  naturally  to  hypersecretion  of 
urine  (Nothnagel).  Gubler  calls  attention  to  the  corresponding 
diminution  of  perspiration,  for  while  the  activity  of  the  sudoriparous 
glands  is  in  proportion  to  the  peripheral  congestion  and  exaltation 
of  the  temperature,  that  of  the  uropoietic  glands  is  in  inverse  ratio 
to  the  vascular  erethism. 

The  urinary  flux  requires  two  opposite  conditions :    The  absence 


196  DIGITALIN 

of  sanguineous  congestion  of  the  kidneys,  the  expansibility  and 
perfect  contractility  of  its  vascular  apparatus,  as  well  as  the  rapid 
circulation  of  the  blood  in  the  interior  of  the  gland.  Increase  of 
tension  becomes  then  an  accessory  circumstance.  The  energized 
cardiac  contractions  have  more  importance ;  they  accelerate  the  flow 
of  blood  into  the  renal  parenchyma,  and  contribute  powerfully  to 
the  definite  result.  The  diuretic  action  of  digitalin  is  the  more  pro- 
nounced, the  more  directly  the  anuria  is  dependent  on  the  disorder 
of  the  circulation ;  and  the  aqueous  plethora  or  the  serosity  in  closed 
cavities  or  cellular  tissues  is  the  more  abundant. 

Digitalin  causes  no  local  effects  when  introduced  into  the  cellular 
tissues. 

Digitonin,  C27  H44  O13  plus  H20,  was  obtained  by  Kiliani  in 
needles  grouped  into  wart-li^e  bodies.  These  dissolve  sparingly  in 
cold  water,  and  do  not  separate  from  a  hot  solution  when  cooled. 
Its  irritative  effects  closely  resemble  those  of  saponin. 

The  digitonin  of  Van  Renterghem  is  a  white  amorphous  powder, 
dissolving  readily  in  water,  or  in  alcohol,  and  is  precipitated  by  tan- 
nic  acid.  He  gives  it  the  formula  of  C31  H52  O17,  as  does  Schmiede- 
berg. 

The  resemblance  of  digitonin  to  saponin  is  so  close  that  Van 
Renterghem  avails  himself  of  studies  of  the  latter,  for  want  of  ac- 
curate observations  on  digitonin.  Hypodermic  injections  of  saponin 
gr.  1 1/2  caused  oedema  and  ery&ipelatous  inflammation  at  the  point 
of  entrance.  Soon  after  there  were  grave  headache  of  the  right 
side,  intense  pains  in  the  eye  and  the  extremities,  with  bodily  and 
psychic  depression.  The  temperature  fell  notably  and  it  was  only 
after  five  hours  of  very  serious  indisposition  that  the  experimentor 
escaped  an  imminent  death. 

Taken  by  the  mouth,  it  excites  cough  and  exaggerated  secretion 
of  the  laryngeal  and  bronchial  mucosa  for  many  hours.  Doses  of 
gr.  I1/?  to  3  do  not  cause  toxic  symptoms,  nor  do  they  augment  the 
secretions  of  the  skin  and  kidneys.  Applied  to  wounds  or  mucous 
surfaces  it  causes  lively  pains  and  plastic  exudations.  Injections 
in  animals  cause  paralysis  of  motor  and  sensory  nerves  around  the 
site  of  the  injections,  extending  towards  the  cord. 

Carried  immediately  to  the  cord,  saponin  after  preliminary 
tetanic  symptoms,  causes  central  paralysis,  extending  to  the 
peripheral  nerves.  The  action  extends  to  the  whole  muscular  sys- 
tem, striated,  cardiac,  and  the  smooth  fibers  of  the  gastrointestinal 
tube.  Entering  the  circulation  it  exerts  a  triple  action  upon  the 


DIGITALIN  197 

heart ;  annihilating  the  excitability  of  the  muscular  tissue,  paralyzing 
the  peripheric  fibers*  of  the  pneumogastric  and  the  inhibitory  centers, 
as  well  as  the  accelerator  nervous  fibers  of  the  sympathetic.  By 
these  the  heart-beats  lose  their  energy,  the  circulatory  center  is 
paralyzed,  arrested  in  diastole. 

With  warm  blooded  animals  these  phenomena  are  followed  or 
accompanied  by  a  fall  in  the  vascular  pressure,  of  the  animal  heat, 
and  of  the  respiration. 

The  administration  of  digitalin  can  prevent  the  death.  Digitonin 
is  less  energetic  than  saponin. 

Toxiresin  and  digitaliresin,  decomposition  products,  closely  re- 
semble picrotoxin  in  their  effects.  By  exciting  the  pneumogastric 
and  the  vasomotor  centers,  they  occasion  weakening  of  the  pulse  and 
elevation  of  the  arterial  pressure. 

Digitonin  forms  half  the  mixed  glucosides  from  the  seed,  but  is 
less  abundant  in  the  leaves.  It  enters  into  the  composition  of 
Germanic  digitalin.  The  yield  is  from  4  to  5  per  cent. 

Digitalein,  C.,,  H:1S  O9,  forms  small  round  granules,  very  soluble 
in  water  and  in  alcohol,  insoluble  in  ether,  chloroform  or  benzol. 

The  taste  is  very  bitter  and  sharp.  It  is  precipitated  by  tannic 
acid.  Administered  hypodermically,  it  causes  no  irritation. 

Schmiedeberg's  digitalein  is  a  yellowish-white  amorphous 
powder,  intensely  bitter.  Merck  gives  the  dose  as  gr.  1-64  to  1-32, 
two  to  four  times  a  day. 

Digitoxin,  C21  H32  O7,  occurs  in  needles  of  nacre  luster,  insolu- 
ble in  water,  soluble  in  chloroform,  or  in  hot  alcohol.  When  ad- 
ministered hypodermically  it  causes  phlegmonous  inflammation. 
The  effects  of  a  medicinal  dose  last  8  to  10  days.  Doses  of  gr.  1-33 
endanger  life. 

It  is  not  precipitated  by  tannic  acid. 

The  emetocathartic  effects  follow  its  topical  application  as>  well 
as  its  administration  by  the  stomach. 

Merck  gives  the  dose  as  gr.  1-250  to  1-125,  three  times  a  day, 
with  3  m.  chloroform,  60  m.  alcohol  and  il/2  oz.  water.  Maximum 
daily  dose  gr.  1-32. 

The  yield  of  digitoxin  is  about  0.4  per  cent.  It  is  very  slow  in 
developing  its  action,  and  may  be  reprecipitated  in  the  alimentary 
canal  and  reabsorbcd  en  masse  later,  thus  throwing  the  whole  effect 
on  the  system  at  once. 

Nativelle's    crystallized    digitalin    consists    of    one-third    pure 


198  DIGITALIN 

digitalin  and  two-thirds  digitin.    The  "pure"  digitalin  is  a  mixture 
of  digitalin,  digitoxin  and  toxiresin. 

Nativelle's  amorphous  digitalin  consists  of  digitalein. 

Homolle  and  Quevenne's  amorphous  digitalin  is  composed 
principally  of  digitalin,  with  the  formula  of  C5  H8  O2. 

Digitalin  Germanic  of  Finzelberg:  A  mixture  of  digitalin  and 
digitalein. 

Pure  digitalin  Germanic:     This  is  principally  digitalein. 

Schmiedeberg  states  that  digitoxin,  digitalin  and  digitalein  exert 
an  absolutely  analogous  action;  the  differences  being  simply  those 
due  to  their  diverse  solubility,  and  energy  of  action.  Digitoxin  is 
from  six  to  ten  times  stronger  than  the  others. 

The  cumulative  action  of  digitalis  has  been  much  discussed. 
Gubler  distinguishes  between  the  accumulation  of  doses  and  that  of 
effects.  Given  in  pills  or  powders,  their  want  of  solubility  or  un- 
favorable conditions  of  absorption  may  cause  an  accumulation  of 
the  doses  in  the  alimentary  tube.  When  the  conditions  here  favor 
solution  and  absorption,  the  whole  collection  may  be  poured  into  the 
blood  at  once. 

The  accumulation  of  action  depends  on  the  elimination,  which 
may  cause  the  retention  in  the  body  of  part  or  all  the  drug,  until 
enough  has  accumulated  to  cause  toxic  effects. 

The  habitual  use  of  a  remedy  also  entails  a  gradual  diminution 
of  its  effects,  as  the  impressibility  of  the  body  diminishes  or  the 
antagonistic  forces  increase. 

The  first  of  these  difficulties,  accumulation  of  doses,  cannot  be 
avoided  as  long  as  the  physician  uses  galenic  preparations,  as  he 
cannot  tell  whether  he  has  simply  given  a  weak  dose,  of  old  leaves 
perhaps,  or  that  the  dose  has  not  been  utilized.  These  perils  are 
avoided  by  the  use  of  the  active  principles.  And  if  all  the  various 
so-called  digitalins  were  retired  but  one,  this  would  quickly  be  done. 
But  since  digitoxin  dominates  in  the  preparation  of  Nativelle,  digi- 
talin in  Homolle  and  Quevenne's,  and  digitalein  in  the  Germanic, 
any  one  of  these  is  preferable  to  the  crude  digitalis,  bearing  in  mind. 
the  difference  in  strength  and  solubility  of  the  three  principles  men- 
tioned. 

Koppe  found  that  two  milligrams  (gr.  1-33)  of  digitoxin,  a 
single  dose,  given  an  adult  man,  caused  toxic  symptoms  very  violent 
and  persisting  many  days.  Megevand  took  one-third  of  a  milli- 
gram (gr.  1-200)  of  Nativelle's  digitalin  once  a  day  for  six  con- 
secutive days.  The  pulse  began  to  slow  on  the  second  day,  fell  more 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


DIGITALIN  199 

rapidly  each  day,  the  lowest  point  being  reached  on  the  seventh  day, 
when  he  felt  nausea  followed  by  vomiting  and  headache,  intense  and 
persisting  till  the  following  day.  The  pulse  had  fallen  to  48,  and  it 
was  not  till  the  I2th  day,  six  days  after  ceasing  the  use  of  the  drug, 
that  it  returned  to  its  normal  rate,  67  to  70. 

The  insolubility  of  digitoxin  in  water  furnishes  a  sufficient  rea- 
son for  discarding  it. 

Megevand  took  for  seven  consecutive  days  a  daily  dose  of  four 
milligrams  (gr.  1-16)  of  Homolle  and  Quevenne's  digitalin.  On 
the  fourth  day  came  the  first  fall  in  the  pulse,  of  five  beats ;  on  the 
sixth  and  fifth  it  fell  to  55 ;  and  it  was  four  days  after  the  cessation 
of  the  drug  that  the  pulse  returned  to  its  normal  rate  of  67.  Toxic 
symptoms  due  to  the  accumulation  of  this  digitalin.  were  observed 
by  Homolle,  as  nausea,  headache  and  delirium.  These  disappeared 
after  24  hours. 

Chemically  pure  digitalin,  and  Homolle  and  Quevenne's  are  but 
slightly  soluble  in  water,  and  present,  after  doses  not  too  strong  and 
repeated  for  some  days,  commencing  intoxication.  They  are  there- 
fore not  the  best  agents1  for  use.  Goerz  used  chemically  pure 
digitalein ;  taking  for  10  days  granules  containing  a  milligram  (gr. 
1-67),  beginning  with  one  granule  and  adding  one  each  day  up  to 
five.  The  pulse  fell  from  54  to  46,  becoming  fuller,  stronger,  but 
more  irritable;  that  is,  after  slight  exercise  it  rose  to  128.  He  felt 
slight  headache,  anorexia,  great  weakness  and  epigastric  pressure. 

Van  Renterghem  took  for  15  days  eight  milligrams  of  digitalin 
Germanic  (digitalein),  in  two  equal  doses.  No  dyspeptic  symptoms 
nor  slowing  of  the  pulse  were  noted.  But  the  same  preparation, 
given  to  a  patient  with  chronic  pneumonia  while  affected  by  a 
hemoptysis  without  fever,  brought  the  pulse  from  96  to  62,  and 
stopped  the  bleeding.  The  remedy  was  given  in  water,  a  milligram 
(gr.  1-67)  every  half-hour. 

In  a  case  of  ascites  Van  Renterghem  obtained  diuresis  and  cured 
the  patient,  without  lessening  the  pulse-rate.  In  a  galloping  phthisis 
the  use  of  Germanic  digitalin,  20  milligrams  (gr.  ^)  a  day,  with 
aconitine,  veratrine,  strychnine  and  quinine,  caused  on  the  I4th  day 
aching  about  the  eyes  and  anorexia;  the  digitalin  was  stopped  and 
the  veratrine  doubled,  when  the  headache  and  dyspeptic  symptoms 
subsided.  He  rives  the  preference  to  this  agent,  as  perfectly  solu- 
ble in  water  and  presenting  the  least  danger  of  cumulation. 

The  organism  easily  accustoms  itself  to  digitalin.  Given  daily 
in  moderate  doses  it  mav  be  continued  for  years  without  toxic  ef- 


200  DIGITALIN 

fects,  but  produces  its  physiologic  action  on  the  cardiac  muscle  and 
prevents  fatty  degeneration. 

Digitalin  is  eliminated  in  part  by  the  kidneys  (Dragendorff). 

Huesemann  calls  attention  to  the  danger  of  accumulation  in 
cases  of  ascites  with  chronic  nephritis  as  the  renal  elimination  is  here 
defective. 

Synergists. — Many  agents  are  ranked  among  the  cardiac 
tonics.  Digitalin,  antiarin,  helleborein,  euonymin,  and  thenetin, 
crystallizable  glucosides ;  scillain,  adonidin,  oleandrin,  non-crystal- 
lizable  glucosides,  little  soluble  in  water;  digitalein,  nerein,  apocynein, 
convallamarin,  amorphous  glucosides,  very  soluble  in  water;  digi- 
toxin,  strophanthin,  apocynin,  not  glucosides,  partly  crystallizable ; 
tanghinin,  nerigdorin,  neriodorein,  upas,  whose  nature  has  not  yet 
been  studied  sufficiently;  erythrophloeine,  an  alkaloid  combining 
the  effects  of  digitalin  and  of  picrotoxin;  phrynin,  derived  from 
some  kinds  of  frogs,  affecting  the  heart  like  digitalin  and  causing 
local  irritation ;  caffeine,  which  regulates  the  heart,  augments  its 
energy,  slows  the  pulse  and  raises  the  arterial  pressure. 

Among  the  auxiliaries  are,  as  antipyretics,  veratrine,  aconitine, 
quinine;  vascular  tonics,  arsenous  acid,  iron,  ergotin,  strychnine; 
as  diuretics,  aconitine,  neutral  alkaline  salts,  turpentine;  as  cerebral 
calmants,  strychnine,  aconitine,  hyoscyamme,  morphine. 

It  is  usually  advisable  to  give  digitalin  when  indicated,  up  to  the 
desirable  effect;  when  this  begins  to  fail,  add  one  of  the  other 
cardiac  tonics,  and  later  another,  instead  of  increasing  the  dose  of 
digitalin. 

Antagonists.  — Atropine  and  chloral  paralyze  the  nerve-ends  of 
the  pneumogastric  in  the  heart,  and  prevent  the  slowing  of  the 
pulse,  without  affecting  the  increase  in  the  arterial  pressure. 

Koehler  says  saponin  antagonizes  digitalin,  and  therefore 
digitonin  does  so  also.  The  stoppage  of  the  heart  in  systole  due  to 
digitalin  is  obviated  by  saponin,  which  neutralizes  the  excitation  of 
the  inhibitory  nerves ;  while  digitalin  in  turn  by  exciting  strongly 
the  cardiac  muscle  suppresses  or  abolishes  the  paralysis  of  saponin. 

If  too  large  a  dose  of  digitalin  has*  been  given,  the  stomach 
should  be  emptied  by  emetics'  and  the  pump  or  lavage,  then  tannic 
acid  given  in  repeated  doses  to  render  the  poison  insoluble;  when 
absorbed,  measures  are  to  be  taken  to  favor  elimination,  saline  purg- 
atives and  diuretics.  Stimulants  should  be  given  internally — 
camphor — and  rubefacients  applied  to  the  skin  with  rubbing,  and 
heat  applied.  Coffee  and  tea  are  contraindicated. 


DIGITALIN  201 

The  danger  in  digitalis  poisoning  may  last  for  several  days,  dur- 
ing which  a  sudden  movement  or  even  p&ychic  excitement  may  oc- 
casion sudden  stoppage  of  the  heart.  Absolute  quiet  must  therefore 
be  enjoined,  even  after  improvement  has  set  in  and  a  subjective 
feeling  of  well-being  is  present.  Anything  calculated  to  occasion 
vomiting  is  to  be  avoided,  such  as  free  drinking. 

But  poisoning  is  usually  due  to  single  large  doses.  The  cumula- 
tive effects  are  limited  to  gastric  irritation,  headache,  stupor;  pre- 
ceded by  nausea,  supraorbital  tension,  weak  feelings  in  the  epi- 
gastrium, photopsia,  insomnia  and  tinnitus. 

These  subside  when  the  medicine  is  discontinued. 

Therapeutics. — The  therapeutics  of  digitalin  is  to  be  deduced 
from  its  action,  in  strengthening  the  heart,  contracting  the  blood- 
vessels, and  increasing  the  excretion  of  urine.  It  is  of  the  utmost 
importance  that  the  physician  using  this  potent  drug  shall  know 
exactly  how  to  secure  the  greatest  benefit  from  it ;  and  just  when  the 
maximum  has  been  attained.  The  indication  of  exact  dosage  is  to 
be  taken  from  the  pulse,  for  the  useful  action  is  manifested  there 
rather  than  in  the  heart  itself.  It  is  obvious  that  digitalin  can  add  no 
real  strength  directly  to  a  weak  heart.  There  is  ao  nitrogenous 
element  in  the  glucoside  that  will  act  as  a  heart  food.  The  benefit 
directly  obtained  from  its  action  on  the  heart  is  therefore  in  the 
nature  of  stimulation — the  whip  that  urges  on  the  tired  horse  a  lit- 
tle farther  when  he  begins  to  flag.  And  there  is  this  further  disad- 
vantage, that  by  contracting  the  coronary  arteries  the  nutrition  of 
the  heart  is  lessened,  and  the  supervention  of  fatty  degeneration 
hastened.  But  if  the  effect  of  digitalin  on  the  arteries  is  taken  as  the 
measure  of  its  activity  we  have  a  very  different  story  to  tell. 

Take  a  membranous  tube,  and  try  to  force  water  through  it ;  the 
force  will  be  expended  in  dilating  the  relaxed  walls  of  the  tube, 
and  you  may  increase  the  force  until  you  burst  the  tube,  and  yet 
you  cannot  force  the  water  through  it.  But  if  you  take  a  tin  tube 
of  equal  length  you  can  with  ease  force  the  water  through.  There  is 
no  force  expended  in  dilating  the  walls.  Now  if  just  enough 
digitalin  is  given  to  impart  normal  tone  to  the  relaxed  blood-vessels, 
a  great  obstacle  will  be  removed  from  the  heart,  and  its  work  will 
be  thus  made  easier.  By  this  the  work  the  organ  must  do  is  reduced 
so  as  to  come  within  the  limits  of  its  strength,  and  with  this  physi- 
ologic rest  there  will  be  an  improvement  of  the  heart's  nutrition.  In 
this  way,  and  in  no  other,  digitalin  may  be  made  curative  to 
maladies  of  the  heart  with  loss  of  power.  And  if  thus  given  the 


202  DIGITALIN 

drug  may  be  continued  for  very  long  periods  without  injury,  but 
with  distinct  benefit.  But  if  the  doses  be  increased  till  the  vessels 
are  abnormally  contracted,  the  heart's  work  will  be  increased  and 
exhaustion  hastened. 

The  only  other  means  by  which  a  weak  or  imperfect  heart  may 
be  made  to  perform  its  vital  functions  indefinitely,  is  by  reducing 
its  work  to  the  limit  of  its  strength ;  and  this  demands  the  lessening 
of  the  bulk  of  the  blood  by  enforcing  the  dry  diet.  If  the  quantity 
of  fluids  taken  into  the  body  daily  is  less  than  the  quantity  cast  out 
by  the  emunctories,  the  weight  falls,  mainly  at  the  expense  of  the 
fluids  of  the  body — the  blood.  If  one  pound  of  useless  water  is 
taken  from  the  blood,  the  heart  is  materially  relieved  in  its  work ; 
and  as  the  same  quantity  of  nutritive  material  is  contained  in  the 
concentrated  blood,  nutrition  does  not  suffer. 

From  the  foregoing  considerations  it  is  evident  that  digitalin 
is  contraindicated  in  any  cardiac  affection  in  which  the  arterial 
tension  is  not  below  normal.  When  the  tension  is  above  normal,  as 
in  atheroma  or  in  cirrhotic  nephritis,  there  is  danger  in  this  drug. 
Fothergill  warned  against  digitalis  in  aortic  stenosis,  and  this  is  a 
wise  caution  when  there  is  atrophy ;  but  when  hypertrophy  has  en- 
sued and  compensation  is  failing,  we  can  obtain  from  digitalin  the 
same  benefit  as  in  mitral  affections. 

Gubler  considers  digitalin  contraindicated  in  aneurisms',  in  cere- 
bral congestions  and  apoplexies.  During  the  period  of  compensa- 
tory hypertrophy  in  valvular  disease  digitalin  is  not  needed  and  its 
use  would  be  dangerous ;  but  when  compensation  begins  to  fail  the 
utility  of  this  drug  is  well  shown.  It  is  equally  applicable  to  this 
condition  of  failing  compensation,  whether  following  mitral  stenosis 
or  insufficiency,  or  mixed  forms,  or  in  aortic  insufficiency;  though 
there  it  has  been  considered  of  doubtful  utility.  Gubler  termed  it 
useless  here;  while  others  have  called  attention  to  the  danger  of 
prolonging  the  diastole  when  the  ventricle  is  already  partly  filled 
with  the  regurgitant  blood.  But  even  here,  if  the  vessels  need  ton- 
ing, there  will  be  distinct  benefit  from  digitalin,  though  it  should  be 
given  in  careful  dosage.  But  advanced  degeneration  of  the  heart- 
substance  as  well  as  hypertrophy,  are  distinct  contraindications. 
Rupture  of  the  feeble  heart-wall  may  result  from  the  powerful  con- 
traction of  the  remaining  muscular  fibers. 

The  effects  are  less  marked  in  affections  of  the  tricuspid,  since 
in  adults  they  occur  as  a  late  effect  of  mitral  disease. 

The  above  view  of  the  place  of  digitalin  receives  confirmation 


DIGITALIN  103 

from  clinical  observations  such  as  these:  Van  Renterghem  says 
that  the  remedy  is  specially  marvelous  if  the  vascular  tension  is 
notably  low.  Traube  and  Fraenkel  remark  that  the  general  symp- 
toms improve  under  its  use,  even  when  no  modification  is  evident  in 
the  frequency  or  regularity  of  the  pulse.  Binz  does  not  consider 
impossible  the  claim  that  cases  of  fatty  degeneration  have  been 
actually  cured  by  prolonged  use  of  digitalin  and  iron,  even  when 
complicated  with  dropsy  and  albuminuria.  He  attributes  the  effect 
to  the  improvement  of  cardiac  nutrition,  comparing  the  effects  with 
those  of  exercise,  electricity  and  massage  on  the  general  muscular 
system. 

Leyden  advised  digitalin  in  maladies  of  the  right  heart  without 
valvular  imperfections  but  with  weakness. 

Huesemann  say&  that  in  paralysis  of  the  left  heart  digitalin  can 
arrest  at  the  outset  the  pulmonary  oedema. 

In  strictly  functional  disorders  it  is  necessary  to  associate  other 
remedies  with  digitalin. 

Binz  thus  summarizes  the  indications  for  digitalin  in  cardiac 
maladies :  Pulse  agitated,  palpitant ;  stases  in  the  lesser  circulation, 
causing  oppression,  bronchial  catarrh,  cardiac  asthma;  arteries 
small  and  empty,  veins  overfull,  skin  cyanotic,  sensation  of  cold, 
nutrition  impaired,  serous  transudations  in  the  subcutaneous  tissues 
of  the  lower  extremities  and  in  the  peritoneum ;  urine  secretion  much 
diminished. 

The  second  use  of  digitalin  is  as  a  remedy  in  fevers  and  inflam- 
mations. 

With  aconitine  it  forms  the  basis  of  the  alkalometric  treatment 
of  fever,  their  use  being  based  on  the  following  reasoning:  The 
first  stage  of  any  inflammation  is  hyperemia,  the  presence  in  the 
affected  tissues  of  an  abnormal  amount  of  blood.  There  is  not  an 
immediate  increase  in  the  body's  supply  of  blood,  but  an  abnormal 
distribution  of  that  previously  existing.  It  follows  therefore  that 
the  presence  of  too  much  blood  in  one  part  necessitates  the  admis- 
sion that  there  is  too  little  blood  somewhere  else.  The  excess  of 
blood  is  at  first  to  be  found  in  the  vessels,  and  the  capillaries  are 
dilated  and  engorged.  But  this  must  mean  that  the  vasomotor 
nerves  governing  the  caliber  of  these  vessels  are  paretic,  else  they 
would  not  permit  the  entrance  of  too  much  blood,  and  the  dilation. 
And  as  the  vessels  elsewhere  have  too  little  blood,  they  must  be  in  a 
spastic  state,  being  unduly  contracted.  Hence,  for  every  vasomotor 
paresis  in  an  inflamed  area  there  is  a  vasomotor  spasm  elsewhere; 


204  DIGITALIN 

and  these  two  conditions  exactly  balance  each  other.  The  begin- 
nings of  an  inflammation  may  be  opposed  either  by  stimulating  the 
paretic  vasomotors  to  contraction,  or  by  relaxing  the  spastic  vaso- 
motors  to  allow  the  blood  to  flow  back  into  the  contracted  vessels 
in  normal  quantity.  All  direct  treatment  of  fevers  is  based  on  one 
or  the  other  of  these  two  therapeutic  principles,  and  the  history  of 
medicine  shows  a  constant  oscillation  between  them — as  was  once 
said,  "we  bleed  down  to  the  brandy  point,  and  then  brandy  up  to 
the  bleeding  point." 

It  remained  for  Burggrgeve  to  demonstrate  the  previously  un- 
suspected fact,  that  both  these  processes  could  be  induced  in  the 
same  body  at  the  same  time;  and  that  the  paretic  cells  would  take 
up  the  needed  doses  of  stimulants,  and  the  spastic  cells  what  they 
needed  of  sedative  agents,  as  each  cell  in  the  body  takes  from  the 
common  supply  of  blood  just  what  food  it  requires  and  passes  the 
rest  by.  Hence,  there  is  no  real  antagonism  between  such  tensors 
as  digitalin  and  relaxants  as  aconitine,  but  when  they  are  adminis- 
tered at  the  same  time  each  does  it&  work  where  it  is  needed.  Tak- 
ing these  as  the  basis,  we  find  that  some  cases  show  an  abnormal 
weakness  of  the  heart  and  of  the  general  vitality ;  and  this  induced 
Burggrseve  to  add  the  powerful  vital  incitant  strychnine  arsenate, 
making  a  triad  whose  efficiency  in  all  asthenic  types  of  fever  leaves 
little  to  be  desired.  And  as  many  cases  show  an  excited,  overacting 
heart,  and  a  deficiency  in  the  elimination  of  toxins  from  the  body, 
Abbott  was  inspired  to  add  that  great  sedative  and  unlocker  of 
elimination  veratrine,  making  a  second  triad  for  the  sthenic  forms 
of  inflammation. 

On  these  two  combinations  is  based  the  alkalometric  treatment 
of  fevers.  By  their  use  the  temperature  is  held  within  safe  limits, 
the  excessive  expenditure  of  vital  force  is  checked,  the  excretion 
of  waste  and  imperfectly  elaborated  products  is  facilitated,  which 
if  retained  in  the  body  would  increase  the  fever;  while  nutrition  is 
favored,  inanition  prevented,  and  the  patient  is  put  in  a  state  to  bet- 
ter resist  the  onslaughts  of  disease. 

The  writer  believes  this  method  compares  favorably  in  intelligi- 
bility and  is  far  superior  in  results  over  the  ordinary  methods  of 
veering  aimlessly  between  alcohol,  quinine,  coal  tars,  strychnine, 
digitalis,  baths,  and  the  procession  of  sedatives  and  stimulants  that 
succeed  each  other  kaleidoscopically. 

The  gentle  but  persistent  action  of  these  alkaloids,  an  action  ex- 
erted upon  the  innate  causes  of  the  derangement  instead  of  simply 


THERAPEUTIC   NOTES 


THERAPEUTIC    NOTES 


DIGITALIN  205 

smothering  the  symptoms  of  their  effects,  commends  itself  to  any 
physician  who  will  sit  down  and  observe  what  follows  their  ad- 
ministration. 

Liebermeister  found  digitalis  useless  or  even  injurious  during 
the  febrile  period,  but  when  the  fever  had  fallen  and  the  pulse  still 
remained  fast,  this  agent  acted  admirably,  in  moderating  the  cardiac 
movements.  Binz  says  that  as  an  antipyretic  digitalis  can  do  no 
good  when  in  fever  the  blood-pressure  is  normal  or  above  normal ; 
but  if  it  is  below  normal  at  the  time  of  the  administration  of  this 
drug  it  will  show  the  same  benefits  as  in  the  corresponding  state 
when  due  to  heart-disease.  Van  Renterghem  calls  attention  to  its 
action  as  a  sedative  to  the  vascular  erethism.  By  contracting  the 
vessels  it  lessens  oxygenation  in  the  tissues,  and  thus  prevents  heat 
production.  The  principal  indications  for  digitalin  are  found  in 
acute  pneumonias,  pleurisies,  endo-  and  pericardites ;  where  it  lowers 
fever,  frees  the  pulmonary  circulation  and  limits  the  spread  of  the 
inflammation.  Associated  with  the  remedies  mentioned,  it  is  of  real 
service  in  typhoid  fever,  the  eruptive  fevers,  acute  continued  fevers 
and  hectic.  It  is  of  value  also  in  acute  ocular  inflammations, 
cystitis,  rheumatism;  in  a  word,  in  all  maladies  characterized  by  a 
rise  in  temperature,  digitalin  and  its  associates  are  of  premier  im- 
portance. 

To  estimate  properly  the  effects  of  digitalin  as  a  diuretic  we 
must  remember  three  influences  that  are  exerted  on  the  excretion  of 
urine :  The  renal  circulation,  the  composition  of  the  blood,  and  the 
nervous  influence.  Digitalin  acts  principally  by  modifying  the  renal 
circulation.  It  is  in  passive  renal  congestions  accompanying  organic 
heart-diseases  and  in  blood  stases  from  functional  circulatory  affec- 
tions that  it  finds  its  field.  The  general  acceleration  of  the  circula- 
tion enables  the  renal  veins  to  better  discharge  their  contents. 
Gubler  says  renal  congestions  are  found  in  simple  nephrites,  those 
dependent  on  diatheses,  such  as  gout,  uricacidemia,  in  the  decline 
of  fevers,  and  analogous  cases.  Digitalin  is  diuretic  by  increasing 
the  renal  vascular  pressure,  not  by  stimulating  the  excretory  ap- 
paratus. It  is  useless  in  hepatic  dropsies,  the  cancerous  cachexia, 
etc.  The  dialysis-stimulants,  the  saline  diuretics,  aid  the  action  of 
digitalin. 

Digitalin  has  a  certain  influence  in  calming  excited  states  of  the 
brain.  Mason  Cox  valued  it  very  highly  in  mania.  I  have  suc- 
ceeded by  its  use  in  quieting  noisy  maniacs  when  all  other  means 
failed.  Fothergill  advised  this  remedy  especially  in  the  mania  of 


206  DIGITALIN 

drunkards,  where  it  relieves  the  cerebral  anemia.  Huss  and  Guns-' 
burg  recommended  it  in  delirium  tremens,  where  it  replaced  opiates 
some  years  ago.  The  tincture  was  given  in  doses  up  to  two  ounces. 
Certainly  digitalis  is  preferable  to  opium,  but  the  eliminants  have  re- 
placed both.  Nevertheless  there  are  cases  in  which  this  remedy  is 
indicated  and  very  beneficial.  The  weak  and  rapid  heart  calling  for 
it  is  sometimes  seen  in  these  subjects. 

Huesemann  advised  digitalin  in  delirium  with  inflammation  and 
fever;  such  as  the  pneumonias  of  drunkards.  But  Gubler  attributed 
the  benefit  to  its  effect  on  the  hyperemia  or  the  fever  present.  And 
as  in  epilepsy  the  crisis  is  always  accompanied  by  an  afflux  of  blood 
to  the  nerve  centers,  we  can  with  benefit  direct  against  it  digitalin, 
as  we  do  other  remedies  such  as-  the  bromides. 

Burggrseve  recommended  to  oppose  to  the  delirium  of  drunkards, 
always  asthenic,  digitalin,  aconitine  and  strychnine;  stimulating  the 
heart,  vasomotors  and  nerve  centers.  The  doses  of  each  are  regu- 
lated by  the  case. 

As  a  remedy  for  hemorrhages,  digitalin  is  too  slow  for  emer- 
gencies ;  but  the  writer  has  had  this  curious  experience :  In  a  num- 
ber of  postpartum  hemorrhages,  he  has  given  ergot  until  the  flow  was 
reduced  to  a  small  one — mere  oozing — and  beyond  this  ergot  would 
not  go,  no  matter  how  large  the  doses.  Then  if  digitalin  were 
given,  the  remaining  hemorrhage  was  stopped  entirely. 

Dosage. — The  subcutaneous  method  is  not  suited  to  digitalin, 
because  even  using  the  soluble  digitalein  it  occasions  some  irritation, 
and  because  a  remedy  demanding  such  nicety  as  to  dosage  requires 
too  many  punctures  when  thus  employed.  To  control  hemorrhages, 
to  combat  depression  resulting  from  snake  bites  or  mushroom 
poisoning,  digitalin  may  be  thus  given  as  an  adjuvant  to  or  sub- 
stitute for  strychnine  or  atropine. 

Merck  gives  the  dose  of  digitalin  "German"  as  gr.  1-64  to  1-32, 
four  times  a  day ;  maximum  daily  dose  gr.  j^. 

Van  Renterghem  advises  for  infants  two  years  old  a  granule, 
gr.  1-67,  every  half-hour;  for  older  patients  two  or  three  granules 
thus  repeated.  Especially  should  the  remedy  be  watched  when 
given  to  a  patient  for  the  first  time,  and  in  nephritis.  Renal  im- 
permeability is  a  contraindication,  as  it  is  of  so  many  other  remedies. 
The  space  of  a  half -hour  between  doses  allows  enough  time  for 
absorption ;  less  than  this  would  not. 

How  soon  does  digitalis  show  its  effects?  Traube  says,  in  24  to 
46  hours;  Rabuteau  puts  the  time  at  10  to  12  hours  for  the  digitalin 


DIGITALIN  207 

of  Homolle  and  Quevenne;  while  Van  Renterghem  claims  that  the 
Germanic  digitalin  displays*  its  physiologic  effect  in  4  to  6  hours. 
If  gastric  irritation  is  manifested  the  remedy  should  be  suspended 
until  all  such  symptoms  have  disappeared.  As  soon  as  the  pulse 
slows,  lessen  the  frequency  of  the  doses,  and  stop  altogether  if  the 
fall  continues  or  when  the  rate  approaches  the  normal.  In  a  young 
and  healthy  man  this  is  about  66  when  lying  down,  71  when  sitting 
and  81  when  standing. 

How  long  may  digitalin  be  given  with  benefit?  Beates  has  ad- 
ministered the  Germanic  digitalin  (digitalein)  to  patients  with 
organic  affections  of  the  heart,  in  doses  of  gr.  *4  thrice  a  day,  for 
years,  without  harm  or  wearing  out  of  the  remedy. 

Some  observers  have  advised  that  a  single  dose  be  given  and 
only  repeated  at  very  long  intervals — one  says  six  weeks.  The  idea 
is  that  as  given  to  compensate  for  the  leakage  of  the  valves,  we 
should  wait  until  there  has  been  an  accumulation  of  surplus  blood 
in  the  ventricle.  But  this  is  obviously  a  priori  reasoning;  and  as  a 
leakage  of  a  single  drop  would  in  an  hour  reach  the  quantity  of 
nearly  half  a  pint,  there  is  a  fallacy  present.  If  the  mechanical 
theory  involved  in  the  "dry  diet"  be  adopted,  it  will  be  found  that 
the  doses  of  digitalin  may  be  gradually  diminished,  as  less  will  be 
needed  to  maintain  the  circulation. 

Liebreich  mentions  as  an  indication  for  stopping  digitalis  the 
occurrence  of  a  pulse  in  pairs,  with  a  longer  interval  after  each 
two  beats. 

Paroxysmal  tachycardia  also  seems  to  be  a  contraindication. 
The  dilation  is  apt  to  indicate  disease  of  the  heart-walls  and  digitalin 
may  then  do  great  harm.  It  is  specially  dangerous  in  cases  with 
fetal  pulse  (Liebreich). 

In  exophthalmic  goiter  digitalis  does  well,  if  given  carefully.  In 
dropsies  with  emphysema  digitalin  is  not  to  be  used  as  long  as  hyper- 
trophy of  the  heart  endures. 

In  hemoptysis  of  phthisis,  digitalin  is  most  valuable  when  the 
heart  is  excited  and  irregular  rather  than  overly  powerful. 

The  enormous  doses  of  digitalis  given  by  Petrescu  for  pneu- 
monia are  now  explained  by  the  weakness  of  the  drug  as  found  in 
Roumania. 

Many  practicians  believe  that  digitalis  has  a  specific  effect  in 
septic  maladies,  combating  sepsis  itself.  This  has  no  foundation 
outside  of  clinical  trials,  and  not  much  there. 


208  DIOSCOREIN 

DIOSCOREIN. 

Standard  granule — Gr.  1-6,  gm.  .01. 

Dioscorein  is  a  concentration  from  the  wild  yam,  Dioscorea 
vittata.  Its  virtues  are  attributed  to  a  resin,  insoluble  in  water  but 
soluble  in  alcohol. 

King  simply  says  that  dioscorea  is  a  specific  for  bilious  colic, 
giving  prompt  and  permanent  relief  in  the  most  severe  cases.  He 
gave  half  a  pint  of  the  decoction  every  half-hour,  or  five  drops  of 
specific  dioscorea  every  five  minutes'.  Webster  extends  its  use  to 
every  form  of  colic,  other  painful  abdominal  neuroses,  and  all 
gastrointestinal  irritations.  If  it  does  not  relieve  in  an  hour  discon- 
tinue the  remedy.  It  allays  the  pain  of  biliary  calculi  when  given 
with  gelsemium.  It  has  proved  useful  in  cholera  morbus  with 
cramps,  neuralgias,  nervous  irritability  with  pain  or  spasms,  hic- 
cough, obstinate  and  painful  vomiting,  gastralgia,  and  in  a  case  of 
asthma  (King). 

Felter  and  Lloyd  say  the  action  appears  to  be  especially  upon 
enfeebled  and  irritable  mucous  membranes,  with  spasm  of  their 
muscular  fibers;  hence  its  use  in  colics,  tenesmus  of  dysentery, 
spasmodic  dysmenorrhea,  and  gastric  spasm  with  pain  and  vomit- 
ing. It  has  been  advised  in  indigestion  with  hepatic  derangement, 
chronic  hepatic  congestion,  chronic  gastritis  of  drunkards,  after- 
pains,  etc. 

Specific  Indications. — Bilious  and  other  colics  with  spasmodic 
contractions ;  yellow  skin  and  conjunctivas,  nausea,  colicky  abdominal 
pains,  coated  tongue,  deranged  stomach ;  frequent,  small,  flatulent 
stools;  colic  with  tenderness,  sharp  abdominal  pain  made  worse  on 
motion. 

Ellingwood  thinks  it  especially  effective  in  malarial  cases,  and 
much  more  certain  in  spasm  and  pain  of  the  bowels,  though  useful 
in  all  spasmodic  pains.  He  advises  it  in  all  uterine  pains  and  in 
ovarian  neuralgia. 

Shoemaker  says  dioscorein  is  expectorant  but  derives  its  chief 
value  from  its  effect  on  the  liver.  It  is  emetic  in  large  doses.  It 
quickly  relieves  pain  and  spasm  of  gall-stones  if  not  too  large  to 
pass,  and  is  useful  to  reduce  irritation  after  the  passage  of  the  stone. 

Hepatic  indigestion  and  its  consequences  are  quickly  relieved  by 
dioscorein.  Hepatic  cirrhosis  seems  to  be  delayed  by  its  use,  and 
it  increases  the  analgesic  effect  of  morphine  in  hepatic  carcinoma. 

The  dose  of  dioscorein  in  spasmodic  and  other  painful  affections 


DUBOISINE    SULPHATE  209 

is  gr.  1-6  to  1-2  every  five  minutes  till  relief,  best  dissolved  in  a  little 
alcohol  or  hot  water.  In  chronic  maladies  give  a  grain  one  to  four 
times  a  day,  in  granules  to  secure  slow  absorption  and  continuous 
action. 

DUBOISINE    SULPHATE. 

Standard  granule^Gr.  1-500,  gm.  .000125. 

While  the  other  alkaloids  of  this  group  are  derived  from  sola- 
naceous  annuals,  this  comes  from  a  tree,  native  to  Australia.  It  is 
also  found  in  minute  quantities  in  belladonna,  stramonium  and  hyos- 
cyamus.  Duboisine  is  isomeric  with  atropine  and  hyoscyamine ;  ac- 
cording to  Nothnagel  identical  with  the  latter  and  according  to 
Merck  identical  with  both.  Foster  says*  the  mydriatic  effect  is  more 
quickly  manifested  than  that  of  atropine  and  does  not  last  as  long; 
that  it  does  not  cause  delirium  like  atropine,  nor  does  it  disturb  the 
respiration.  Gushing  thinks  the  plant  and  the  alkaloid  contain  at 
times  hyoscine  or  hyoscyamine. 

Duboisine  has  been  recommended  in  exophthalmic  goiter  to  allay 
the  circulatory  disturbance,  but  it  has  no  control  over  the  course  of 
the  malady. 

Dr.  Gate  published  an  interesting  account  of  its  application  in  a 
case  of  Laloneurosis,  which  will  be  found  in  American  Alkalometry, 
Vol.  I,  page  434. 

If  there  are  really  differences  in  these  rarer  members  of  the 
atropine  group,  they  are  yet  to  be  demonstrated.  According  to 
Merck  there  are  but  two  alkaloids  in  this  group,  atropine  and  hyos- 
cine, the  others  being  merely  mixtures  of  these  two,  and  modifica- 
tions that  do  not  materially  affect  their  therapeutic  effects.  It  seems 
that  a  fruitful  field  of  experiment  awaits  the  investigator  as  to  the 
effects  of  varying  proportions  of  these  two  alkaloids  when  adminis- 
tered together. 

Nothnagel  gives  the  dose  of  duboisine  as  gr.  1-80  to  1-30,  and 
yet  declares  it  is  less  than  that  of  atropine.  The  standard  granules 
of  duboisine  contain  gr.  1-5000,  and  this  may  be  repeated  every  ten 
minutes  until  the  atropine  symptoms  appear — dryness  of  the  mouth 
first,  then  flushed  skin,  dilated  pupils,  etc. 

In  therapeutic  applications,  effects,  toxic  and  remedial,  antidotes, 
etc.,  it  closely  resembles  atropine. 


aio  ECHINACEA 

t 

ECHINACEA. 

The  best  preparation  of  Echinacea  angustifolia  as  yet  available 
is  the  extract. 

Lloyd  terms  echinacea  a  corrector  of  deprivation  of  the  body 
fluids.  Its  extraordinary  powers  combine  those  included  under  the 
terms  antiseptic,  antifermentive  and  antizymotic.  It  controls  the 
disturbed  balance  of  the  fluids  resulting-  in  such  tissue  changes  as 
are  presented  by  boils,  carbuncles,  abscesses,  cellular  glandular  in- 
flammations ;  serpent  or  insect  venom,  malignant  diphtheria,  cere- 
brospinal  meningitis,  puerperal  and  other  septicemias ;  "bad  blood," 
asthenia,  adynamia,  the  tendency  to  malignancy.  Septic  wounds  are 
treated  with  this  agent.  In  cerebrospinal  meningitis  Webster  found 
it  best  for  cases  with  weak  puls,e  not  fast,  little  fever,  cold  extrem- 
ities, headache,  peculiar  flushing  of  face  down  to  neck,  dizziness  and 
profound  prostration.  As  a  stimulant  to  the  capillary  circulation 
he  found  no  equal  to  echinacea.  It  endows  these  vessels  with  re- 
cuperative force.  Lloyd  doubts  the  value  of  this  agent  in  malignant 
diphtheria,  having  failed  with  it.  In  non-malignant  cases  it  ap- 
peared to  expedite  recovery.  It  gave  him  better  success  in  tonsil- 
litis with  dirty,  ulcerative  surfaces.  The  form  of  quinsy  known  in 
the  west  as  black  tongue  has  responded  to  echinacea.  It  aids  in  the 
cure  of  respiratory  catarrhs,  with  offensive  ulceration,  dark  color 
and  debility.  It  has  overcome  the  fetor  of  pulmonary  gangrene  and 
given  early  has  prevented  that  catastrophe.  Shelley  reported  a 
typhoid  pneumonia  with  jet  black  tongue  which  improved  on 
echinacea. 

Lloyd  has  used  it  in  fermentative  dyspepsia,  with  bad  breath  and 
gastric  pain,  worse  on  eating;  in  duodenal  catarrh,  intestinal  in- 
digestion with  pain  and  debility ;  ulcerative  stomatitis,  nursing  sore 
mouth,  diarrhea,  dysentery,  cholera  morbus  and  infantum,  typhlitis 
and  perityphlitis ;  eruptive  fevers,  especially  the  catarrhal  phases 
and  angina  of  scarlet  fever.  It  has  done  best  in  typhoid  and  typho- 
malarial  fevers,  and  in  sympathetic  fevers  from  rheumatism  or 
sepsis.  King  found  it  fail  in  every  case  of  ague.  Others  find  it  use- 
ful in  asthenic  malaria.  It  occasionally  aids  in  influenza,  and  as- 
sists convalescence.  Puerperal  septicemia  yields  to  echinacea  but 
curetting  must  be  done  if  indicated.  The  succeeding  debility  is  re- 
lieved by  echinacea.  Hayes  commends  it  in  mountain  fever. 

Echinacea  relieves  pain  of  erysipelas,  aiding  resolution  when 
extensive,  tense  and  purplish-red;  of  cancer,  especially  of  the 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


ECHINACEA  211 

fauces ;  removing  the  odor  promptly ;  cancerous  cachexia ;  tubercular 
abscesses,  gangrene,  empyema  with  pulmonary  gangrene,  ap- 
pendicitis (Farnum)  ;  phlegmonous  swellings,  old  sores,  erysipelas 
with  sloughing,  phagedena,  dissecting  and  surgical  wounds, 
phlegmasia  dolens,  dermatitis  venenata,  and  pus  cavities. 

As  a  local  remedy  Lloyd  speaks  of  echinacea  for  malignant  car- 
buncle, painful  mammitis,  gonorrhea,  syphilis,  impotence,  purulent 
salpingitis,  offensive  leucorrhea,  erythematous  and  erysipelatous 
vulvitis  (Webster),  eczema  with  asthenia  and  general  depravity 
(physical,  we  suppose). 

Post-scarlatinal  dropsy  has  been  reported  as  cured  by  echafolta ; 
also  as  preventing  hydrophobia.  It  has  been  recommended  for 
smallpox,  as  relieving  the  symptoms  of  phthisis,  especially  the  cough 
of  stone-cutters'  phthisis ;  and  Lloyd  suggests  that  it  may  favorably 
impress  the  tubercular  diathesis. 

Specific  Indications. — To  correct  fluid  depravation,  bad  blood, 
tendency  to  sepsis  and  malignancy,  as  in  gangrene,  sloughing  and 
phagedenic  ulcerations,  carbuncles,  boils  and  various  forms  of 
septicemia ;  foul  discharges  with  weakness  and  emaciation ;  deep- 
ened, bluish  or  purplish  color  of  skin  or  mucosa,  with  low  inflam- 
mation ;  dirty-brownish  tongue,  jet  black  tongue,  multiple  cellular 
abscesses  semiactive  with  marked  asthenia;  especial  importance  in 
typhoid,  septicemia  and  other  adynamic  fevers ;  malignant  carbuncle, 
pulmonary  gangrene,  cerebrospinal  meningitis  and  pyosalpinx; 
locally  to  annul  pain  and  correct  fetor  of  open  cancers. 

Ellingwood  says  that  when  tincture  of  echinacea  is  taken  into  the 
mouth  it  causes  tingling,  somewhat  recalling  that  of  aconite,  which 
remains  for  half  an  hour.  Swallowed  undiluted  it  causes  a  sense  of 
constriction,  promotes  the  flow  of  saliva,  followed  by  diaphoresis 
and  if  repeated  by  diuresis.  The  functions  of  all  the  glands  seem 
to  be  stimulated.  The  appetite  and  digestion  improve,  the  bowels 
act  better,  absorption,  assimilation  and  nutrition  are  enhanced.  It  en- 
courages secretion  and  excretion,  preventing  further  autointoxica- 
tion and  correcting  what  has  occurred.  It  stimulates  tissue  waste 
more  than  any  other  remedy  known.  Sallow,  pallid  and  dingy 
skins  become  rosy.  Anemias  improve  and  gain  tone.  It  is  the  rem- 
edy for  blood  poisoning.  The  field  covers  acute  autoinfection,  slow 
progressive  blood  taint,  imperfections  of  elimination  and  germic  af- 
fections. The  special  indication  is  the  tendency  to  gangrene  and 
sloughing  of  soft  tissues,  throat  dark  and  full,  tongue  full  with 
dirty  dark  brown  or  black  coat,  in  all  cases  where  there  is  sepsis  or 


212  ELATERIUM 

zymosis.  As  an  intestinal  antiseptic  he  places  echinacea  in  the  first 
rank.  In  typhoid  fever  treated  by  it  the  extreme  limit  of  duration 
is  21  days  and  some  report  a  week  as  the  limit.  In  uremic  poisoning 
it  will  supersede  all  other  single  remedies.  In  cholera  infantum  it 
is  specially  useful  when  nervous  phenomena  are  present. 

Dr.  Meyer  used  echinacea  for  hemorrhoids,  injecting  it  into  the 
rectum  three  times  a  day.  He  records  613  cases  of  rattlesnake  bite 
successfully  treated  by  this  agent. 

Dr.  F.  M.  Friend  testifies  to  the  value  of  echinacea  in  all  cases 
of  sepsis.  He  employed  it  in  a  desperate  case  of  scarlet  fever  with 
success. 

All  accounts  agree  that  there  is  little  if  any  effect  from  this  drug 
when  given  to  a  person  in  health.  Its  effects  are  only  manifested 
when  there  is  an  enemy  to  encounter.  And  if  it  is  useless,  there  are 
a  good  many  capable  observers  who  have  been  badly  mistaken. 

The  dose  of  the  best  preparation,  Lloyd's  echafolta,  is  from  two 
to  ten  drops  every  two  hours. 


ELATERIUM. 

Standard  granule — Gr.  1-6,  gm.  .01. 

This  agent  is  the  active  principle  of  the  Momordica  elaterium, 
one  of  the  gourd  family  to  which  we  owe  so  many  valuable  med- 
icines. In  July  the  proportion  of  elaterin  is  about  0.4  per  cent,  and 
in  August  when  the  plant  matures  it  rises  to  0.7  per  cent.  In  Sep- 
tember it  vanishes  completely ;  a  circumstance  which,  as  the  Chemist 
and  Druggist  says  of  a  similar  variability  in  hydrastis,  does  not  in- 
terest the  manufacturers  of  galenic  preparations,  but  does  those  who 
extract  alkaloids.  Possibly  it  may  interest  the  physician. 

Elaterin  is  insoluble  in  water,  slightly  soluble  in  ether,  readily  in 
boiling  alcohol  and  in  alkalies.  It  requires  the  presence  of  bile  to 
develop  its  activity.  It  is  the  type  of  the  drastic  hydragog  cathartics, 
acting  powerfully  on  the  bowels  an  hour  after  it  is  taken,  even  more 
promptly  than  croton  oil.  The  place  of  elaterin  is  in  threatened 
uremia  or  apoplexy,  cerebral  hyperemia,  when  it  is  essential  to  re- 
move a  portion  of  the  toxic  material  from  the  blood  to  prevent  con- 
vulsions, or  to  reduce  the  cerebral  vascular  tension  as  rapidly  as 
possible.  Here  nothing  but  venesection  equals  the  speedy  action  of 
elaterin.  These  emergencies  come  to  the  physician  rarely,  but  when 
they  do  come  the  danger  is  imminent  and  haste  is  imperative.  Hence 


EMETINE  213 

the  vade  mecum  case  should  always  contain  a  vial  of  elaterin  gran- 
ules, though  but  few  in  number. 

The  standard  granules  contain  gr.  1-6,  and  of  these  one  should 
be  given  every  five  minutes,  or  five  at  once,  if  possible  with  an  alkali 
like  ammonia  to  hasten  solution  and  action.  Overdoses/  call  for 
stimulants  and  anodynes,  hot  whisky,  hot  enemas,  camphor  and  cap- 
sicin,  with  atropine  in  full  doses  hypodermically. 

EMETINE. 

Standard  granules — Gr.  1-67,  gm.  .001 ;  gr.  1-6,  gm.  .01. 

Among  the  eccentricities  encountered  by  the  physician  who  ad- 
heres to  the  use  of  ipecacuanha  is  the  uncertain  derivation  of  his 
supply.  Four  plants  contribute  to  the  ipecac  of  the  market: 
Cephaelis  ipecacuanha,  Psychotria  S.  Ronabea  emetica,  Richardsonia 
scabra  St.  Hilaire,  lonodium  ipecacuanha  Ventenat.  Of  these  the 
first  three  belong  to  the  family  of  Rubiacese,  the  other  to  the 
Violaceae.  The  first  has  about  four  times  the  activity  of  the  others. 

As  early  as  1817  Pelletier  and  Magendie  obtained  emetin,  which 
they  recommended  in  place  of  the  crude  drug,  being  100  times  as 
active,  and  devoid  of  disagreeable  taste  and  odor.  The  galenic 
preparations  of  ipecacuanha  are  notoriously  unstable  and  variable 
in  strength,  while  emetine  is  stable  and  uniform  in  strength,  and  if 
the  irritant  cephaeline  is  excluded,  is  far  less  liable  to  cause  emesis 
in  doses  that  still  fully  afford  the  valuable  action  on  the  digestive 
apparatus  to  which  the  principal  effect  is  due. 

Emetine  does  not  change  when  exposed  to  the  air.  It  is  soluble 
in  1,000  parts  of  cold  water,  more  readily  in  hot  water,  and  quite 
easily  in  alcohol  or  in  ether.  It  is  bitter.  It  dissolves  easily  in  acids 
forming  acid  salts,  and  is  precipitated  by  vegetable  astringents. 

The  percentage  of  emetine  in  the  crude  drug  is  so  variable  that 
no  accurate  dosage  can  be  based  thereon.  Pelletier  obtained  only 
0.78  per  cent,  while  Zenoffsky  secured  3.8  per  cent.  But  Rabuteau 
declares  that  the  ringed  bark  contains  16  per  cent,  the  striated  9 
per  cent,  and  the  wavy  3  to  4  per  cent.  His  method  of  extraction  is 
as  follows :  The  ipecac  is  mixed  with  a  little  water,  potassium  or 
sodium  nitrate  added, the  emetine  precipitates  as  a  nitrate,  in  a  mass; 
this  is  washed,  dissolved  in  alcohol,  decomposed  by  milk  of  lime; 
the  mixture  dried  in  a  water  bath,  powdered  and  when  digested 
with  ether  gives  up  to  it  all  its  alkaloid.  Evaporating  the  ether 
there  remains  a  yellowish  substance,  which  is  treated  with  sulphuric 


214  EMETINE 

acid.  Emetine  alone  dissolves  in  the  solution,  and  when  dilute  am- 
monia is  added  the  alkaloid  is  deposited  as  a  white  precipitate,  which 
is  then  washed  with  cold  distilled  water.  Emetine  thus  obtained  is 
pure. 

Physiologic  Action. — Magendie  found  that  half  a  grain  of  im- 
pure emetine  caused  vomiting  in  dogs  or  cats,  often  followed  by  pro- 
longed sleep.  Ten  grains  caused  vomiting  in  dogs,  after  which  the 
animals  became  drowsy;  but  instead  of  returning  to  health  as  when 
small  doses  of  emetine  were  given,  the  animals  died  within  24  hours. 
Death  was  due  to  a  profound  inflammation  of  the  lungs  and  the  in- 
testinal mucosa  from  the  cardia  to  the  anus.  The  same  results  en- 
sued when  emetine  was  injected  into  the  jugular  vein  or  absorbed 
from  any  part  of  the  body. 

Two  grains  of  emetine  taken  fasting  by  a  well  man  caused  pro- 
longed vomiting  followed  by  a  pronounced  disposition  to  sleep. 
One-fourth  of  a  grain  sufficed  to  produce  vomiting.  Given  to  a  sick 
man  it  caused  vomiting  and  stools  as  with  a  well  man,  influencing 
in  a  happy  manner  catarrhal  affections,  especially  when  chronic. 
Huesemann  found  that  emetine  produced  a  cathartic  effect  not  ob- 
tainable from  ipecac,  in  which  the  crude  vegetable  matters  hinder 
this  action. 

Applied  to  the  skin  in  ointment  emetine  causes  after  some  time  a 
sense  of  burning,  forms  pustules  with  a  red  areola,  and  continual 
absence  of  appetite.  If  continued  long  enough  it  causes  ulceration 
of  the  skin  to  which  it  is  applied.  Introduced  in  the  eye  it  causes 
inflammation  of  the  conjunctiva  and  cornea;  in  the  nose  incessant 
sneezing;  in  the  air  passages  cough,  swelling  of  the  mucosa  and 
respiratory  troubles  (Buchheim).  A  concentrated  alcoholic  solu- 
tion left  in  contact  with  the  tongue  produces  a  sense  of  warmth 
quite  different  from  that  caused  by  aconitine  or  by  veratrine.  In- 
jected under  the  skin  it  causes  local  inflammation  which  renders 
this  mode  of  administration  unavailable.  But  if  thus  used  it  oc- 
casions vomiting  as  when  given  by  the  stomach. 

Emetine  is  eliminated  by  the  gastric  mucosa  and  by  the  kidneys 
(Dragendorff).  The  local  action  on  the  gastric  ends  of  the  pneu- 
mogastric  causes  a  secondary  excitation  of  the  vomitive  center.  For 
Pecholier  and  d'Ornellas  found  that  the  emetic  action  was  suppress- 
ed by  section  of  the  vagus. 

The  nausea  is  more  decided  when  the  drug  is  introduced  through 
the  stomach. 

A  very  light  dose — gr.  1-134  to  1-67 — by  the  mouth,  causes  a 


EMETINE  215 

slight  sense  of  warmth  in  the  stomach,  like  that  following  a  small 
dose  of  arsenic.  A  larger  dose  repeated,  gr.  1-30  to  1-12,  causes 
yawning  nausea,  free  salivation  and  finally  vomiting.  Meanwhile 
the  bronchial  and  intestinal  mucous  secretions  are  increased.  Still 
larger  doses  cause  prompt  vomiting,  followed,  as  are  moderate  doses 
if  repeated,  by  liquid  stools.  Collapse  and  death  may  result  if  the 
doses  are  large  enough.  Rutherford  introduced  ipecac  directly  into 
the  duodenum  of  dogs  and  observed  an  increase  in  the  secretion  of 
bile  and  of  the  intestinal  mucus.  The  pulse  is  accelerated  by  an 
emetic  dose  up  to  the  occurrence  of  vomiting ;  it  then  falls  even  be- 
low normal.  If  vomiting  does  not  occur  the  heart  action  is*  retarded. 
Toxic  doses  can  cause  death  by  cardiac  paralysis.  The  effect  on 
the  respiration  is  quite  similar. 

Emetine  has  no  direct  influence  on  the  central  nervous  system. 
It  causes  muscular  depression.  During  the  nausea  the  cutaneous 
glands  are  active.  Therapeutic  doses  have  no  appreciable  effect  on 
the  urinary  secretion  but  toxic  doses  may  cause  albuminuria. 

Emetine  is  said  to  occasionally  cause  hyperemia  or  oedema  of  the 
lungs ;  to  dissolve  the  red  cells  when  injected  intravenously ;  and  to 
rarely  cause  urticaria  when  taken  by  the  mouth.  Shoemaker  is 
quite  positive  as  to  its  cholagog  action.  At  any  rate,  when  given  in 
a  single  full  dose  at  bedtime  and  retained,  the  evacuations  next 
morning  are  those  usually  denominated  bilious,  and  the  effects  are 
such  as  are  attributed  to  clearing  out  of  this  organ.  In  fact,  it  has 
seemed  to  the  writer  that  not  even  calomel  so  completely  unloads 
the  liver. 

Van  Renterghem  says  that  except  violine  emetine  has  no  syner- 
gist.  All  emetics  are  auxiliaries.  Pilocarpine  sometimes  causes 
vomiting,  but  it  is  ranked  with  emetine  rather  for  its  action  in  in- 
creasing the  secretion  of  the  bronchial  mucosa. 

The  narcotics  retard  the  nauseant  action,  as  well  as  the  purga- 
tive ;  while  the  aromatics  and  stimulants  do  this  and  also  combat  the 
general  depression  and  tendency  to  collapse.  Cocaine  as  a  local 
anesthetic,  and  the  strychnine  group  as  incitants  of  the  nervous 
system,  prevent  or  retard  the  nauseant  effects  of  emetine,  but  act  as 
auxiliaries  when  one  desires  the  other  effects  without  the  nausea. 

The  only  antidote  is  tannic  acid,  which  precipitates  emetine  in  an 
insoluble  tannate.  Gallic  acid  and  all  the  vegetable  astringents, 
iodine,  iron  and  lead,  are  chemically  incompatible  with  emetine. 

Therapeutics. — Emetine  fills  the  multifarious  role  of  an  emetic, 


216  EMETINE 

expectorant,  digestive,  antispasmodic,  hemostatic,  diaphoretic  and 
defervescent. 

As  an  emetic  it  is  mild  in  action  and  the  nausea  does  not  long 
remain  after  emesis.  It  is  specially  valuable  when  the  indication  is 
to  relieve  the  stomach  of  undigested  food.  For  children  emetine  is 
useful  as  it  depresses  less  than  most  other  emetics. 

The  nurse  should  be  warned  that  sometimes  the  vomiting  does 
not  occur,  and  that  the  remedy  should  be  suspended  when  the  bowels 
act  or  symptoms  of  depression  occur. 

As  an  expectorant  emetine  is  indicated  when  there  is  a  deficiency 
in  the  bronchial  secretion,  or  when  the  latter  is  tough  and  adherent. 
Dry  cough  calls  for  emetine.  This  is  the  case  in  the  early  stages  of 
acute  bronchitis  and  laryngitis ;  and  in  chronic  cases-  with  scanty 
secretion.  When  the  same  condition  is  present  in  early  phthisis 
emetine  may  be  given.  In  spasmodic  asthma  emetine  must  be  pushed 
to  nausea  for  benefit  to  accrue.  In  whooping-cough  it  is  usually 
given  in  the  catarrhal  stage,  with  little  if  any  benefit.  In  fact,  the 
failure  of  such  remedies  usually  first  arouses  the  suspicion  that  we 
have  this  malady  to  deal  with. 

As  a  digestive  emetine  is  useful  in  all  cases  where  the  digestive 
fluids  are  deficient.  In  very  small  doses,  well  within  the  nauseating 
limit,  it  is  well  suited  to  gastric  and  duodenal  catarrhs,  and  to  the 
dry  forms  of  ileocolitis1.  In  most  forms  of  acute  intestinal  irrita- 
tions, simple  diarrheas,  cholera  infantum,  cholera  morbus,  when- 
ever the  intestinal  secretions  are  vitiated  and  unhealthy,  the  stools 
unduly  fetid,  emetine,  promotes  the  secretion  of  healthier  products. 
In  dysenteries  of  the  graver  types,  tropical,  foudroyant,  it  is  a 
specific.  Given  in  doses  of  a  grain  with  every  precaution  to  prevent 
vomiting  emetine  exerts  a  degree  of  control  over  this  malady  not 
approached  by  any  other  remedy.  The  patient  should  be  prepared 
for  the  night,  in  bed,  and  then  take  the  dose  in  tablets,  which  must 
be  swallowed  whole  and  dry,  with  no  fluid ;  he  then  must  lie  perfect- 
ly quiet  for  half  an  hour,  and  before  the  expiration  of  this  he  will 
be  asleep. 

When  he  awakes  in  four  to  eight  hours  he  will  be  markedly  im- 
proved. If  the  dose  is  vomited  it  should  be  at  once  repeated. 
Sometimes  it  will  be  necessary  to  first  administer  a  small  hypo- 
dermic of  morphine  to  insure  the  retention  of  the  emetine. 

Emetine  in  similar  doses  administered  in  the  same  manner  con- 
stitutes one  of  the  most  effective  remedies  for  delirium  tremens. 
Many  times  I  have  given  a  grain  at  bedtime  to  a  patient  in  the  be- 


THERAPEUTIC   NOTES 


THERAPEUTIC    NOTES 


EMETINE  217 

ginning  of  an  attack,  and  wild  with  the  incessant  craving  for 
whisky ;  within  30  minutes  he  would  be  asleep,  and  after  eight  hours' 
rest,  awake  free  from  the  craving,  and  ready  for  his  food.  This 
dose  produces  one  or  two  spinach-colored  stools,  and  if  it  does  not 
act  on  the  liver  there  is  every  appearance  of  such  action. 

To  obtain  antispasmodic  effects  from  emetine  it  is  necessary  to 
administer  it  in  nauseant  doses,  sufficient  to  produce  muscular  re- 
laxation. Given  thus  it  has  proved  of  use  in  uterine  spasm,  etc.  But 
the  most  important  application  in  this  group  is  to  the  spasms  of 
childhood,  usually  dependent  on  unwholesome  food  and  relieved  by 
emesis.  Repeated  spasms  with  muscular  relaxation  form  the  pic- 
ture of  a  case  suitable  for  emetine. 

The  hemostatic  effect  is  due  to  the  relaxation  of  arterial  tension, 
and  also  requires  nauseant  or  emetic  doses:  But  as  vomiting  itself 
may  favor  the  hemorrhage  the  object  is  to  secure  relaxation  without 
pushing  to  the  emetic  dose.  This  can  easily  be  accomplished  by  the 
intensive  method  of  rapidly-repeated  minute  doses,  stopping  the 
moment  nausea  is  felt. 

As  a  diaphoretic  emetine  is  not  of  much  importance,  pilocarpine 
being  immeasurably  more  powerful.  There  are  few  conditions  in 
which  Dover's  powder  is  not  advantageously  replaced  by  the  latter. 

The  antipyretic  influence  of  emetine  does  not  depend  on  a  direct 
effect  upon  the  pulse  rate  or  the  temperature,  unless  it  is  given  in 
toxic  doses.  The  effect  is  rather  to  be  attributed  to  the  opening  of 
the  excretory  channels,  allowing  the  materies  morbi  to  pass  out  of 
the  body.  This  is  best  shown  in  pulmonary  inflammations',  when 
emetine  is  given  in  doses  sufficient  to  promote  secretion  and  relax 
tension.  Emetine  goes  very  well  with  the  defervescent  alkaloids, 
veratrine  and  aconitine,  but  antagonizes  digitalin  to  some  extent. 
As  a  diaphoretic  ipecac  has  always  been  administered  with  opium, 
as  in  Dover's  powder.  The  writer  has  modified  this  old  favorite  in 
accordance  with  modern  therapeutics,  by  using  emetine  and  codeine, 
with  camphor  monobromide.  This  forms  an  excellent  combination 
for  a  diaphoretic  and  a  soothing  remedy  for  dry  irritative  coughs. 
It  has  less  tendency  to  nauseate  and  constipate  than  the  old  Dover's 
powder,  and  is  more  speedily  effective  and  manageable. 

For  use  in  chronic  constipation  and  other  chronic  affections  of 
the  alimentary  canal  emetine  is  administered  with  aloin,  atropine, 
strychnine  and  capsicum,  sometimes  adding  physostigmine  for 
flatulence,  or  podophyllin  to  affect  the  liver  more  decidedly.  For 
gastric  affections,  especially  of  infants,  an  excellent  combination 


218  EMETINE 

consists  of  emetine,  rhein  or  juglandin,  and  sodium  carbonate  and 
sulphocarbolate,  with  aromatics.  Innumerable  combinations  are 
made  of  emetine  with  other  remedies;  in  fact,  it  is  far  more  fre- 
quently thus  used  than  alone. 

In  India  the  treatment  of  the  severe  dysenteries  common  there 
by  ipecacuanha  has  become  established  as  the  standard.  Many  ex- 
periments have  been  made  with  ipecac  deprived  of  its  emetine,  since 
it  is  recognized  that  vomiting  must  not  be  allowed.  On  the  whole 
the  evidence  is  not  conclusive  as  to  the  superiority  of  the  deemetized 
drug.  But  experiments  made  by  the  writer  show  a  great  advantage 
in  the  use  of  the  amorphous  emetine,  which  has  been  freed  from 
cephaeline,  the  acrid  emetic  principle  of  ipecac  root.  I  have  taken 
a  grain  of  this  in  whole  tablets  with  no  nausea  whatever,  though 
one-twelfth  of  a  grain  in  warm  solution  will  nauseate  me  promptly. 

Shoemaker  enumerates  the  following  uses  for  ipecac:  Locally, 
as  a  remedy  for  insect  bites,  2.  parts  to  15  each  of  alcohol  and  ether ; 
also  in  watery  solution  for  rhus  poisoning;  and  the  wine  sprayed 
into  the  air  passages  for  emphysema,  fibroid  phthisis,  winter  cough 
and  chronic  bronchitis  (Murrell)  ;  internally  very  small  doses  for 
nausea  and  vomiting,  of  pregnancy  or  of  alcoholism ;  hemoptysis, 
epistaxis  and  metrorrhagia ;  to  overcome  uterine  inertia  in  the  first 
stages  of  labor;  to  free  the  bronchi  of  secretion  in  whooping-cough 
or  in  capillary  bronchitis;  pushed  to  full  tolerance  in  epilepsy 
(Bond)  ;  dram  doses  of  the  powder  for  cholera  morbus  and 
Asiatica ;  tuberculous  diarrhea  and  night-sweats ;  torpor  of  the 
liver ;  flatulent  dyspepsia ;  to  stimulate  the  liver  in  malarial  poison- 
ing; catarrhal  jaundice;  laryngismus  stridulus;  puerperal  hemor- 
rhages and  dysenteries  (Trousseau)  ;  hematemesis  (Burland)  in 
dram  doses. 

King  says  the  specific  indication  for  ipecac  is  the  presence  of 
irritation,  even  enumerating  mental  and  nervous  irritation  in  his  list. 
His  chief  indications  are:  Elongated  and  pointed  tongue,  red  tip 
and  edges,  large  or  effaced  papillae ;  tenderness  on  pressure ;  contrac- 
tion of  tissues;  pinched  countenance,  white  line  around  mouth, 
tendency  to  nausea  and  vomiting,  with  or  without  eructations,  and 
marked  hyperesthesia.  Hyposecretion,  capillary  engorgement,  cases 
acute.  These  indications  presenting  in  gastric,  enteric,  pulmonary, 
maladies  call  for  ipecac,  or  better  for  emetine.  Hemorrhagic  cases 
calling  for  ipecac  are  nervous  individuals  with  marked  irritability 
and  vascular  excitation.  Bleeding  hemorrhoids  are  sometimes  bene- 
fited by  this  remedy. 


ERGOTIN  219 

A.  L.  Blesh  has  sometimes  succeeded  in  having  the  grain  dose 
retained  in  cases  of  dysentery  by  first  partially  anesthetizing  the 
stomach  with  a  single  large  dose  of  cocaine.  At  other  times  a  pre- 
cedent large  dose  of  carbolic  acid  has  accomplished  this  object. 

G.  M.  Jameson  of  Buda,  Texas, praises  emetine  for  the  dry  cough  ; 
of  severe  forms  6f  measles.  He  gives  gr.  1-32  to  1-16  every  half- 
hour  to  one  hour. 

Blake  (Merck's  Archives}  claims  that  ipecac  in  full  doses 
energizes  the  circulation,  accelerating  the  blood-current  but  lessen- 
ing its  volume,  the  vasomotor  spasm  in  the  skin  accumulating  the 
blood  centrally,  causing  congestion  and  albuminuria.  The  skin  cools 
and  the  heat  rises  internally.  In  bad  hygienic  conditions  with  weak 
digestion  and  faulty  elimination  small  doses  of  ipecac  are  curative 
by  stimulating  ganglionic  energy,  hastening  circulation  and  promot- 
ing the  nutritive  processes,  also  by  stimulating  elimination.  In 
croup  it  loosens  the  membrane  by  the  thin  mucous  secretion  exuding 
under  it.  In  spinal  exhaustion,  from  over-exertion,  heat  or  teething, 
the  blood  is  centralized,  the  solar  plexus  irritated,  and  vomiting  and 
purging  result.  Very  small  doses  of  ipecac  frequently  repeated, 
direct  the  blood  to  the  surface  and  relieve  alimentary  congestion. 
By  increasing  capillary  innervation  it  checks  choleraic  discharges, 
menorrhages,  syncope,  and  diseases  of  old  age,  and  causes  uterine 
contractions. 

Dosage. — If  nausea  or  emesis  is  desired  emetine  should  be  ad- 
ministered in  warm  water;  but  if  the  effect  on  the  liver,  or  the 
hypnotic  action  is  indicated,  or  if  for  any  reason  it  is  best  that  the 
remedy  should  not  be  vomited,  the  granules  or  tablets  should  be 
swallowed  whole  and  dry,  that  absorption  may  be  slow.  As  a 
diaphoretic  and  for  most  uses  the  dose  is  gr.  1-67  repeated  every 
five  to  sixty  minutes',  or  less  frequently.  In  dysentery  and  delirium 
tremens  from  gr.  1-6  to  gr.  j,  is  the  dose,  and  this  may  be  repeated 
every  8  to  24  hours. 

ERGOTIN. 

Standard  granule— Gr.  1-6,  gm.  .01,  and  tablets  gr.  2,  gm.  .13- 
This  drug  is  so  well  known  that  it  needs  but  little  description. 
Ergot,  ergot  of  rye,  Secale  cornutum  is  the  sclerotium  of  a  parasitic 
fungus,  Claviceps  purpurea,  which  replaces  the  normal  grain  of  rye, 
Secale  cereale.  The  supply  is  derived  chiefly  from  Russia,  Germany 
and  Spain.  Some  attempt  has  been  made  to  replace  the  standard 


220  ERGOTIN 

article  with  corn  ergot  but  the  latter  has  not  proven  satisfactory. 
Ergot,  in  its  natural  condition,  is  horn-shaped,  somewhere  in  the 
neighborhood  of  an  inch  in  length,  externally  of  a  purplish  black 
and  upon  fracture  white  with  a  pinkish  streak.  The  odor  is  dis- 
agreeable and  peculiar  and  the  taste  oily  and  nauseous. 

This  body  has  different  active  principles  and  its  chemistry  has 
even  at  this  late  day  yet  to  be  fully  settled.  Ergotinic  acid,  cornutine 
and  sphacelinic  acid  are  three  impure  bodies  which  have  been 
separated  but  none  of  these  represents  properly  the  activity  of  the 
entire  drug.  Ergotinic  acid  is  toxic  and  if  injected  intravenously 
causes  ecchymoses  and  wide-spread  inflammation ;  cornutine  often 
causes  convulsions  and  sphacelinic  acid  causes  gangrene.  Quite 
recently  Jacobi  has  isolated  sphacelotoxin  which  he  claims  repre- 
sents the  active  principle  of  sphacelinic  acid.  The  preparations  of 
the  drug  are  many.  The  fluids  are  variable  in  potency ;  some  are 
inert  and  the  best  are  often  unfit  to  be  injected  subcutaneously.  The 
fluid  and  solid  extracts  are  used  largely  and  the  varying  reports  as 
to  the  efficiency  or  uselessness  of  the  drug  are  due  to  the  different 
preparations  used. 

Ergotin,  which  alone  is  used  alkaloidally,  is  a  purified  hydro- 
alcoholic  extract  of  ergot  and  gives  in  practice  the  most  even  and 
certain  results.  This  preparation  is  not  affected  to  any  marked  ex- 
tent by  age  or  exposure  as  is  every  other  form  of  ergot.  It  may  be 
given  internally  or  hypodermically  with  equally  good  effect  and 
abscesses  do  not  follow  its  exhibition  in  the  latter  manner. 

Physiologic  Action. — There  exists  a  wide  difference  of  opinion 
as  to  the  physiological  action  of  ergot.  We  know,  however,  that  it 
increases  parturient  action ;  that  in  moderate  doses  it  constricts  the 
arterioles  in  various  portions  of  the  body  and,  as  a  result,  arterial 
pressure  is  somewhat  raised.  The  drug  has  a  stimulant  effect  upon 
the  vasomotor  center  and  also  probably  has  a  direct  effect  upon  the 
muscular  coats  of  the  blood  vessels.  It  is  not  always  suitable  for 
prolonged  administration  as  it  has  a  tendency  to  produce  gangrene. 

Given  hypodermically,  or  intravenously,  in  medicinal  doses,  the 
blood  pressure  is  first  lowered  and  then  raised,  the  preliminary  fall 
being  supposedly  due  to  the  temporary  depression  of  the  heart 
muscle  from  direct  contact  with  the  drug.  Given  by  the  mouth  its 
action  is  rapid;  within  thirty  minutes,  often,  its  effect  is  apparent 
and  the  impression  lasts  fully  an  hour.  In  emergencies  (post- 
partum  hemorrhages)  from  2  to  5  grains  may  be  given,  preferably 
hypodermically.  A  fresh  solution  should  be  made  at  the  bedside 


ERGOTIN  221 

and  the  solution  may  be  filtered  through  sterile  gauze  if  time  allows. 
In  severe  floodings  the  dose  may  be  repeated  in  half  an  hour  and 
as  ergot  is  really  as  far  as  obstetric  indications  are  concerned  an 
emergency  remedy,  the  accoucheur  should  always  provide  himself 
with  a  supply  of  a  'reliable  preparation.  Many  of  those  upon  the 
market  are  absolutely  inert. 

Therapeutics. — In  all  bleedings  from  the  uterus,  whether  due  to 
fibroids,  cancer  or  parturient  accidents,  ergotin  is  our  most  useful 
remedy  when  pure.  In  fibroids  the  drug  should  be  given  in  smaller 
doses,  either  by  the  mouth  or  by  hypodermic  injection.  The  treat- 
ment should  be  continued  for  weeks.  There  is  a  marked  reduction 
in  the  size  of  the  tumor  and  often  it  seems  to  become  absorbed.  In 
the  worst  cases  it  ceases  to  increase  in  size. 

In  the  parturient  woman  small  doses  induce  uterine  contractions 
closely  resembling  the  normal.  If  full  doses  are  given,  however, 
these  become  powerful  and  tetanic.  As  there  is  a  vast  difference  in 
patients'  tolerance  of  this  drug,  it  is  difficult  to  estimate  what  will 
be  a  safe  dose.  It  has  therefore  become  a  rule  never  to  administer 
ergot  until  delivery  has  been  accomplished.  A  full  dose  will  then 
often  expel  the  placenta  and  cause  firm  contraction  of  the  uterus. 
When  after  the  third  stage  the  uterus  remains  flaccid  and  "boggy" 
two  or  three  moderate  doses  of  ergotin  (gr.  I  to  2)  will  cause  a 
marked  change  for  the  better.  It  is  a  mistake,  however,  to  give 
ergot  as  a  routine  measure  as  so  many  practicians  are  in  the  habit 
of  doing.  In  cases  known  to  be  post-partum  "bleeders"  a  full  dose 
may  be  given  after  the  head  is  born.  In  subinvolution  it  is  a  useful 
remedy  but  the  possibility  of  affecting  the  nursing  child  should  be 
borne  in  mind. 

Ergotin  has  proven  of  undoubted  service  in  metrorrhagia,  gr. 
1-6  to  1-2  being  given  every  two  hours  till  effects  are  produced.  In 
heniatemesis,  hemoptysis  and  hematuria  its  use  is  questionable ;  in 
hemoptysis  especially  it  would  seem  to  do  more  harm  than  good. 

Ergotin  causes  contraction  of  the  sphincter  vesicae  and  this  often 
produces  annoying  symptoms ;  it  is  therefore  evident  that  it  will 
prove  a  reliable  remedy  in  incontinence.  It  may  be  combined  with 
strychnine  with  advantage.  Wherever  it  is  desirable  to .  contract 
involuntary  muscular  fiber,  there  ergotin  is  indicated  and  as  the 
smaller  blood-vessels  are  largely  formed  of  involuntary  muscle 
fibers  it  may  be  given  to  lessen  capillary  blood  supply.  It  is  there- 
fore indicated  in  congestive  headaches — especially  in  those  of  a  full 
habit. 


222  ERGOTIN 

The  drug-  has  also  been  used  with  success  in  diabetes  insipidus 
and  colliquative  sweats.  Various  writers  have  also  recommended 
it  as  a  useful  remedy  in  diabetes  mellitus,  meningitis,  myelitis, 
splenic  enlargements,  acute  dysentery  and  skin  diseases.  In  all  of 
these,  however,  with  the  possible  exception  of  splenic  enlargement, 
it  has  proved  unsatisfactory. 

Ergot  remains  what  it  has  always  been,  the  obstetrician's  best 
friend.  Its  action  upon  the  uterus  is  prompt  and  powerful  and,  if  a 
reliable  preparation  is  used  in  sufficient  quantity,  the  desired  effect 
can  always  be  obtained.  Given  internally  ergotin  may  produce 
nausea  but  this  form  of  the  drug  is  less  objectionable  in  this  respect 
than  the  fluid  extracts. 

In  giving  ergotin  hypodermically  the  solutions  should  not  be 
thrown  under  the  skin  but  deep  into  muscular  tissue.  In  this  man- 
ner the  formation  of  abscesses  is  almost  positively  avoided.  Quinine, 
hydrastin,  gossypin,  can  in  certain  instances  take  the  place  of  ergotin 
to  some  extent.  Some  practicians  are  in  the  habit  of  administering 
a  full  dose  of  quinine  as  soon  as  labor  sets  fairly  in  and  give  a  dose 
of  ergotin  as  soon  as  or  immediately  after  the  head  is  born. 

Ergotin  has  been  recently  recommended  as  an  efficient  remedy 
in  puerperal  fever.  It  has  been  used  not  only  as  a  specific  but  as 
a  prophylactic.  In  a  series  of  thirty  cases  Solt  used  ergotin  through- 
out the  sickness  and  says  every  case  recovered  with  a  rapidity  never 
before  witnessed.  Other  observers  support  this  claim. 

Moderate  doses  for  a  prolonged  period  have  been  suggested  in 
multiple  sclerosis. 

In  all  cases  of  disordered  circulation  ergotin,  it  is  suggested, 
should  be  given  hypodermically.  It  is  capable  of  restoring  tone  and 
equilibrium  to  the  circulation ;  many  writers  have  recently  asserted 
that  it  is  more  valuable  than  most  of  the  accepted  heart  tonics.  The 
adminstration  by  the  mouth  is  condemned.  Within  the  year  large 
doses  given  hypodermically  have  been  warmly  recommended  in  all 
acute  inflammatory  infections.  Meningitis,  pneumonia,  pericarditis 
and  erysipelas  are  among  the  diseases  enumerated  as  being  success- 
fully treated  with  ergotin.  It  has  also  been  found  to  relieve  the 
serous  apoplexy  of  alcoholics  and  is  useful  in  pulmonary  edema. 
In  conjunction  with  strychnine,  ergotin  is  recommended  in  chorea. 
The  convulsive  condition  is  ameliorated  and  the  general  tone  of  the 
patient  improved. 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


EUONYMIN  223 

ERYTHROL    TETRANITRATE. 

Erythrol,  also  termed  erythroglucin,  phycite  and  erythrite,  is  a 
principle  existing  in  many  lichens  and  in  some  algae.  The 
tetranitrate  is  explosive  on  quick  heating  or  percussion,  like  nitro- 
glycerin.  It  is  given  in  the  same  manner  and  for  the  same  purpose, 
that  of  quickly  dilating  the  capillaries.  It  is  slower  in  action  and 
more  lasting.  The  dose  is  gr.  y2  to  one  grain,  repeated  every  four 
to  six  hours.  It  may  be  given  in  tablets.  The  field  of  this  agent 
seems  to  be  amply  covered  by  sodium  nitrite. 


EUONYMIN. 

Standard  granules — Gr.  1-67,  gm.  .001 ;  gr.  1-6,  gm.  .01. 

Euonymin  is  a  resinous  body  derived  from  Euonymus  atro- 
purpureus,  wahoo.  By  the  same  name  is  designated  a  crystalline 
glucoside  whose  action  closely  resembles  that  of  digitalin. 

Felter  and  Lloyd  term  euonymus  tonic,  laxative,  alterative, 
diuretic,  and  expectorant.  It  has  been  used  successfully  for  inter- 
mittents,  dyspepsia,  torpid  liver,  constipation,  dropsy  and  pulmonary 
affections.  It  stimulates  the  flow  of  bile,  and  is  recommended  for 
ague  after  quinine  has  broken  the  chills.  It  stimulates  digestion 
and  improves  appetite.  It  may  be  used  for  atonic  dyspepsia,  in- 
digestion from  torpid  liver  or  from  malaria,  for  chronic  malaria  and 
the  indigestion,  constipation  and  gastric  debility  with  or  after  it; 
for  dropsy  with  hepatic  and  renal  inactivity. 

Specific  Indications. — Prostration  with  irritation  of  the  nerve 
centers ;  periodic  diseases,  to  supplement  quinine ;  anorexia,  indiges- 
tion, constipation,  all  from  hepatic  torpor. 

Ellingwood  says  euonymus  is  actively  cathartic  and  alterative, 
through  its  influence  on  the  glands.  He  considers  it  indicated  in 
phthisis  with  night-sweats  and  great  weakness,  dropsies  following 
acute  affections,  convalescence  from  severe  agues,  enlarged  liver 
and  chronic  bronchitis.  It  is  a  good  remedy  for  indigestion  and 
constipation  with  yellow  conjunctiva  and  around  the  mouth,  the 
tongue  coated  similarly.  Also  for  torpid  liver  and  weak  digestion, 
constipation  and  lithemic  neuralgia.  It  is  a  hepatic  stimulant,  im- 
proving the  protoplasmic  function  of  the  liver  and  increasing  the 
bile. 

Shoemaker  says  euonymus  first  increases  and  then  lessens  the 
excretion  of  uric  acid.  It  is  said  to  cause  the  disappearance  of  the 


224  EUPURPURIN 

albumin  from  the  urine  in  nephritis.  It  also  relieves  that  form  of 
lumbago  that  is  rather  a  soreness  than  actual  pain. 

The  dose  of  euonymin  for  an  adult  is  gr.  i  to  3,  at  bedtime. 

Of  Merck's  white  euonymin  Van  Renterghem  took  gr.  */§  every 
hour  till  10  doses  had  been  taken.  Two  soft  stools  were  passed, 
without  the  least  pain  in  the  abdomen,  no  influence  on  the  appetite 
or  the  pulse.  He  also  tried  the  brown  and  the  green  euonymin,  in 
doses  up  to  gr.  xv  each.  It  was  only  on  passing  doses  of  six  grains 
that  he  felt,  six  or  eight  hours  after  taking  it,  a  slight  increase  in 
peristalsis,  followed  by  the  usual  stool.  Even  15  grains  did  not 
cause  laxity  or  colic.  No  effect  on  the  pulse. 

Evidently  euonymin  is  not  to  be  looked  upon  as  a  violent  drastic. 
Its  effect  seems  to  be  in  the  line  of  correcting  abnormalities  in  the 
hepatic  functions.  Senator  praised  it  as  a  remedy  for  jaundice,  the 
simple  catarrhal  form.  In  duodenal  catarrh  it  has  done  well  in  the 
hands  of  the  writer;  giving  gr.  1-6  every  two  hours,  or  a  much 
larger  dose  at  bedtime. 

EUPURPUEIN. 

Standard  granule — Gr.  1-6,  gm.  .01. 

Eupurpurin  is  a  concentration  from  the  Eupatorium  purpureum, 
queen  of  the  meadow,  or  gravel  root. 

Lloyd  says  this  plant  possesses  diuretic,  subastringent,  stimulant, 
tonic  and  antilithic  properties.  It  has  a  specific  action  on  the  kid- 
neys, increasing  both  the  solid  and  the  liquid  constituents  of  the 
urine.  Even  those  who  will  not  allow  its  repute  of  dissolving 
calculi  admit  that  it  controls  the  irritation  of  the  bladder  caused  by 
these  bodies.  It  has  also  been  advised  in  renal  dropsy,  chronic 
mucous  affections  of  the  gastrointestinal  tract,  post-scarlatinal 
dropsy,  difficult  and  painful  micturition  with  frequent  desire  to 
urinate,  the  passage  seemingly  obstructed;  pain  and  weight  in  the 
loins  extending  to  the  bladder,  urine  scanty  and  high-colored,  or 
mixed  with  blood ;  chronic  vesical  irritation,  a  sense  of  heat  in 
bladder,  urine  milky  and  loaded  with  mucus,  adhering  to  the  vessel ; 
strangury  from  irritant  drugs  or  blisters,  shooting  urethral  pains, 
vesical  tenesmus  and  frequent  micturition ;  hematuria  and  recent 
prostatitis  after  the  acute  stage  passes ;  irritable  bladder  in  children ; 
and  of  pregnancy ;  diabetes  insipidus ;  vomiting  of  pregnancy  ac- 
companied by  coughing  when  a  little  urine  escapes;  efficient  in 
albuminuria ;  gout  and  rheumatism ;  chronic  cough  with  weak  cir- 


GELSEMININE  225 

culation  and  in  asthma,  catarrh  and  unduly  prolonged  whooping- 
cough  ;  impotence ;  female  disorders ;  chronic  irritability  of  the 
womb  and  atony;  habitual  abortion  from  prolapsus,  retroversion, 
debility  from  chronic  metritis,  or  other  atonic  states ;  as  an  injection 
in  chronic  amenorrhea  with  great  debility  and  constant  leucorrhea. 

Specific  Indications. — Vesical  irritation,  incontinence  of  urine, 
painful  and  frequent  urination,  urine  scanty  and  milky  with  mucus 
or  blood ;  uric  acid  diathesis ;  pain  and  weight  in  loins  extending  to 
bladder;  skin  dry,  hot  and  constricted. 

Ellingwood  terms  it  specific  for  irritation  of  the  bladder  from 
displacement  and  chronic  metritis ;  suppression  of  urine  partial  or 
complete,  during  or  after  pregnancy.  He  says  it  is  also  of  service  in 
chronic  endometritis,  insufficient  labor  pains,  ovarian  and  uterine 
atony,  dysmenorrhea,  burning  or  dull  aching  in  the  bladder, 
anasarca,  ague  with  lumbar  chills,  violent  shaking  with  little  sweat- 
ing, severe  bone  pains,  frontal  headache,  weak  tired  feeling,  hectic 
with  night-sweats;  it  increases  retrograde  metamorphosis  and  elim- 
inates the  poison  causing  rheumatism ;  acts  on  the  ganglionic  system 
and  improves  digestion. 

The  dose  of  eupurpurin  is  from  gr.  1-6  to  i  three  or  four  times 
a  day.  It  is  usually  best  taken  in  hot  water,  before  meals  and  at 
bedtime.  In  the  chronic  maladies  in  which  it  is  recommended  quick 
results  are  scarcely  to  be  expected.  Give  moderate  doses  for  a 
month  at  least. 

Buckley  recommended  eupurpurin  for  colicky  pains  and  similar 
attacks  pointing  to  affections  of  the  lumbar  region,  and  in  chronic 
catarrhal  diseases  of  the  bladder  and  kidneys.  He  gives  one  or  two 
granules  every  two  or  three  hours. 

GELSEMIN.    GELSEMININE. 

Standard  granules— Gelsemin,  gr.  1-134,  gm.  .0005;  gelseminine,  gr.  1-250, 
gm.  ..00025. 

Two  alkaloids  are  derived  from  Gelsemium  sempervirens, 
gelsemine  and  gelseminine.  The  first  resembles  strychnine  in  its 
action  but  is  much  weaker.  Gelseminine  is  a  powerful  poison,  re- 
sembling cicutine  in  most  of  its  effects  (Cushny).  To  the  latter  the 
effects  of  the  crude  drug  are  due. 

Physiologic  Action. — The  symptoms  from  gelseminine  are  quite 
similar  to  those  of  cicutine,  but  the  former  depresses  the  central 
nervous  system  more.  Death  is  caused  by  paralysis  of  the  respira- 


226  GELSEMININE 

tory  center.  Applied  locally  it  dilates  the  pupil  widely,  less  so  when 
taken  internally.  The  power  of  accommodation  is  lost.  But  this 
action  differs  from  that  of  atropine  in  that  gelseminine  causes 
paralysis  of  the  inhibitory  ganglia  while  atropine  paralyzes  the 
terminals.  Gelseminine  does  not  increase  the  arterial  tension. 

It  is  one  of  the  most  certain  and  powerful  depressors  of  the 
motor  nerves.  Toxic  doses  cause  drooping  of  the  upper  eyelids, 
and  this  is  the  signal  for  stopping  the  medicine.  Reflex  irritability 
is  lowered,  the  gait  is  staggering,  numbness  is  manifest,  but  the 
cerebral  functions  are  unimpaired  until  carbonic  acid  poisoning  sets 
in.  The  pulse  is  slowed  only  as  the  excitomotor  cardiac  ganglia  are 
affected.  The  temperature  is  lowered.  Great  muscular  weakness 
ensues.  The  arterial  pressure  falls. 

Poisoning  from  gelsemium  calls  for  stimulant  doses  of  strych- 
nine, hot  drinks  and  pediluvia,  rubbing  and  other  means  of  keeping 
up  the  heat,  and  artificial  respiration.  The  stomach  should  be 
evacuated.  Atropine  and  morphine  hypodermically  are  advocated 
by  Shoemaker.  Tannic  acid,  alkalies  and  their  carbonates  are 
chemical  antidotes.  A  dram  of  the  fluid  extract  has  caused  death. 

Felter  and  Lloyd  say  that  small  doses  relax  the  muscles  and 
allay  nervous  irritation,  causing  a  pleasant  sense  of  ease;  larger 
doses  cause  the  lower  jaw  to  droop  as  well  as  the  eyelids ;  vision  is 
confused,  and  still  larger  doses  paralyze  the  spinal  cord.  Toxic 
symptoms  are  profound  prostration  and  muscular  relaxation,  drop- 
ping of  the  under  jaw  and  upper  eyelids,  dilated  pupil  and  diplopia. 
The  temperature  falls  and  the  pulse  slows  to  30  beats.  Death  has 
followed  the  ingestion  of  12  minims  of  fluid  extract  by  a  child  of 
three  years.  Poisoning  is  alleged  to  have  occurred  from  the  use  of 
honey  gathered  from  the  jessamine  blossoms. 

Therapeutics. — Gelsemium  acts  particularly  on  the  cerebrospinal 
centers,  lessening  their  supply  of  blood ;  hence  its  use  in  all  cases 
wherein  there  is  a  determination  of  blood  to  the  brain  and  cord. 
While  these  writers  recommend  it  for  all  cerebrospinal  inflamma- 
tions they  say  it  is  never  the  remedy  for  congestion.  Scudder  gives 
as  specific  indications,  the  flushed  face,  bright  eye,  contracted  pupil, 
increased  heat  of  head,  great  restlessness  and  excitation.  With  these 
may  be  general  headache.  Such  conditions  arising,  gelsemium  will 
be  found  of  use  in  bilious,  remittent,  typhoid  and  malarial  fevers. 
It  is  best  adapted  to  the  earlier  stages  of  fevers,  sthenic  forms,  and 
is  to  be  stopped  the  moment  its  physiologic  effects  are  manifest,  to 
avoid  the  subsequent  depression.  It  is  said  that  the  full  constitu- 


GELSEMININE  227 

tional  effect  impairs  the  tonicity  of   the   cardiac   muscle.      It  is  of 
marked  value  in  pneumonia,  pleurisy,  and  especially  in  puerperal 
fever.     Chilly  sensations  on  movement  indicate  it.     Bloyer  says  it 
is  specially  useful  for  nervousness  with  exaggerated  complaints  over 
trifles — "touchiness."     It  allays  excitement  and  restores  secretion  to 
prepare  the  way  for  quinine;  in  children's  fevers  and  convulsions 
from    dentition,   gastrointestinal    inflammations,   cholera   infantum, 
diarrheas  and  dysenteries;  in  hysteria,  convulsions  with  muscular 
cramps,  neuralgia  with  powerful  nervous  twitchings,  toothache  of 
pregnancy  and  of  periodentitis,  facial  neuralgia  from  caries,  cold 
or  nerve  excitation ;  insomnia,  pain  from  nervous  tension,  and  local 
hyperemia ;  headache  from  eye  strain,  migraine,  nervous,  bilious  and 
in     myalgia    and     tic     douleureaux — give     in     small     and     rapid 
dosage.     For  ovarian  neuralgia  give  full  doses.     It  relieves  inter- 
costal neuralgia,  sciatica,  dysenteric  tenesmus,  bowel  spasms,  chorea, 
epilepsy,  tetanus,  urinary  spasms,  passage  of  renal  calculi,  scanty 
urine  with  irritation  of  the  passages,  anuria  from  irritation  not  con- 
gestive ;  it  is  the  remedy  for  dysuria  from  spasmodic  urethral  stric- 
ture, hysteric  retention,  gonorrhea  and  spermatorrhea  in  plethoric; 
in  early  chordee  no  remedy  is  so  prompt.     In  spasmodic  conditions 
with  cystic  catarrh,  inflammations  along  the  genitourinary  tract; 
pelvic  maladies  of  women,  ovaritis,  metritis  and  salpingitis,  dys- 
menorrhea  and  uterine  colic,  rigid  os  uteri  with  dryness,  it  relaxes 
all  sphincters,  thus  facilitates  labor — give  free  doses.    Alone  or  with 
pulsatilla  it  overcomes  the  nervous  restlessness  of  parturients  and 
the  nervous  tension  following  labor,  as  well  as  afterpains  and  some 
leucorrheas.    By  blunting  peripheral  sensation  it  relieves  the  itching 
of  eczema  and  prurigo;  applied  locally.   It  has  succeeded  in  delirium 
tremens,  mania  and  paralysis.      King    used  it    with    advantage  in 
iritis,  conjunctivitis,  muscular  asthenopia,  and  tinnitus  aurium,  giv- 
ing small  doses  every  four  hours  and  carefully  avoiding  depressing 
effects.    Parrish  obtained  benefit  from  it  in  alcohol  and  opium  habits. 
Gastrointestinal  irritation  with  a  sense  of  rawness,  heat  and  pain, 
knotty  contraction  in    the    stomach,    call    for   gelsemium.      In  the 
exanthemata  great  heat  and  restlessness  call  for  this  remedy,  and  it 
is  nearly  always  required  in  cerebrospinal  meningitis.    No  one  rem- 
edy was  more  frequently  indicated  in  influenza,  with  persistent  fever 
and  headache,  with  great  excitability.  It  has  been  used  in  whooping- 
cough,  spasmodic  cough,  spasm    of  the    glottis,    asthma,    hysteric 
cough,  excessive  heart  action  of   hysterics,    vertigo,    hemorrhages, 
ague-cake,  gout,  rheumatism,  bronchitis,  laryngitis,  albuminuria,  and 


228  GELSEMININE 

many  other  affections.  This  long  list  shows  how  great  is  the  repute 
of  gelsemium  with  the  eclectics.  Felter  and  Lloyd  give  as  specific 
indications:  Bright  eyes,  contracted  pupils,  flushed  face,  great  heat 
and  restlessness ;  mental  irritability ;  insomnia  with  excitation ;  pain 
over  the  whole  head;  dysuria  with  scanty  urine,  irritation  of  the 
urinary  tract;  pinched,  contracted  tissues;  thin,  dry,  unyielding  os 
uteri  with  dry  vaginal  walls ;  chilly  sensations  on  motion ;  hyperemia, 
and  convulsions. 

Ellingwood  says  the  earlier  successes  with  gelsemium  were  due 
to  the  full  doses  given.  Children  are  more  susceptible  than  adults 
to  it.  In  spasms  maximum  doses  are  needed.  Toxic  effects  are 
readily  recognized  and  obviated  without  harm  resulting.  Gelsemium 
is  quickly  eliminated  through  the  kidneys  and  the  doses  must  be  soon 
repeated.  Single,  full  doses  should  be  given  only  to  adults.  In  one 
case  evidences  of  poisoning  came  on  in  45  minutes  after  taking  a 
dram  of  the  fluid  extract. 

To  Lloyd's  list  he  adds :  Recent  torticollis,  laryngismus  stridulus, 
irritable  heart-action,  acute  nephritis  from  cold,  acute  cystitis  with 
great  irritation  and  spasm;  neuralgias  nearer  the  head  are  more 
under  its  control. 

Synergists. — Macrotin  when  the  muscles  are  affected,  heart  and 
genitourinary  cases ;  passiflora,  bromides,  chloral,  cicutine,  physo- 
stigmine,  veratrine.  Antagonists  are  alcohol,  strychnine,  digitalin, 
ammonia,  and  to  some  extent  atropine  and  caffeine.  Coffee  is  an 
antidote. 

Shoemaker  says  gelsemium  is  frequently  beneficial  in  lumbago; 
might  control  the  spasms  of  hydrophobia ;  as  a  substitute  for  mor- 
phine. Ringer  found  the  tincture  beneficial  in  small  doses — m.  x 
t.  i.  d. — in  Meniere's  disease.  It  will  sometimes  arrest  attacks  of 
bilious  colic,  in  doses  of  m.  5  every  fifteen  minutes.  It  is  of  con- 
siderable service  in  treating  hemoptysis,  and  a  full  dose  may  abort  an 
acute  coryza.  Nottage  found  it  useful  in  menopause  headaches  with 
flushes,  head  and  body  hot — gtt.  2  to  3  every  three  hours. 

Walling  took  gelseminine  every  fifteen  minutes  to  break  up  a 
cold.  Four  doses  did  the  work  and  induced  dizziness.  Another 
case  took  six  granules  with  like  success;  but  the  patient  said  the 
medicine  made  him  drunk.  These  doses  were  gr.  1-134  each,  and 
they  were  evidently  too  strong.  Reducing  to  gr.  1-250,  no  further 
trouble  was  experienced. 

Dr.  M.  G.  Price  of  Mosheim,  Tenn.,  cured  a  case  of  neuralgia 
with  gelseminine  after  the  galenic  preparations  of  the  same  drug 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


GERANIN.     GLONOIN  229 

had  proved  worthless.  In  influenza  Barnes  gives  gelsemium  with 
strychnine  for  the  fever,  aches  and  pains,  cough  and  restlessness. 
He  credits  it  with  a  special  action  on  the  ophthalmic  division  of  the 
fifth  nerve. 

The  virtues  of  gelsemium  are  fully  represented  by  gelseminine, 
and  this  alone  should  be  used,  the  concentration  gelsemin  being 
dropped,  and  the  galenic  preparations  also,  for  their  uncertainty. 
The  dose  of  gelseminine  is  gr.  1-250  repeated  every  quarter-hour  in 
acute  cases  and  every  two  hours  in  chronic  ones. 

GERANIN. 

Standard  granule — Gr.  1-6,  gm.  .01. 

Geranin  is  a  concentration  from  the  rhizome  of  Geranium 
maculatum.  The  active  principle  is  tannic  acid,  which  in  the  dried 
root  changes  to  gallic  acid.  The  yield  varies  from  28  per  cent  in 
spring  to  10  per  cent  if  gathered  in  October.  The  virtues  of 
geranium  are  those  of  the  vegetable  astringents.  Whether  there  is 
any  advantage  in  using  the  plants  instead  of  the  pure  tannic  acid 
each  physician  will  decide  for  himself. 

Therapeutics. — As  an  astringent  geranin  may  be  employed  in  the 
relaxed  stages  of  diarrheas,  dysenteries,  choleraic  affections,  and 
locally  for  hemorrhages,  ulcers,  aphthae,  ophthalmia,  gleet,  leucor- 
rhea,  salivation,  and  any  place  where  an  astringent  is  indicated.  It 
has  also  been  given  internally  for  diabetes,  menorrhagia,  hematuria, 
chronic  mucous  discharges,  of  all  kinds.  In  chronic  pharyngeal 
catarrh  it  has  been  employed  as  a  gargle ;  and  it  has  been  advised 
even  as  a  remedy  for  incipient  tuberculosis.  King  recommends  it 
with  aletris  for  diabetes  and  nephritis.  It  is  applied  to  bleeding 
hemorrhoids,  epistaxis,  bleeding  from  small  wounds  and  from  tooth 
cavities,  etc.  King  wisely  advises  the  addition  of  berberine  in  most 
of  the  cases  enumerated  above.  Like  other  of  the  tannin  astringents 
this  is  advised  as  pleasanter  and  less  irritant  than  the  acid  itself,  and 
this  may  be  true.  But  the  use  of  tannic  acid  in  granules  leaves  lit- 
tle to  be  desired  when  a  vegetable  astringent  is  indicated. 

GLONOIN. 

Standard  granule — Gr.  1-250,  gm.  .0025. 

Glonoin  is  the  one  remedy  whose  effects  are  more  quickly  mani- 
fested when  taken  by  the  mouth  than  when  administered  hypo- 
dermically.  Within  a  minute  after  taking  a  dose  the  patient  feels 


230  GLONOIN 

a  sense  of  fullness  in  the  head,  with  throbbing,  and  the  face  and 
neck  flush.  Darwin  pointed  out  that  the  area  affected  corresponds 
exactly  with  that  of  ordinary  blushing.  Brief  headache  follows,  and 
a  sense  of  impending  dissolution  if  the  dose  has  been  too  large.  If 
very  large  doses  are  taken  there  is  vertigo,  prostration,  and  stupor. 
The  respiration  is  rapid,  and  irregular,  but  shallow.  Within  five 
minutes  these  effects  pass  off,  and  leave  the  patient  none  the  worse. 
There  is  an  instant  and  profound  fall  in  the  vascular  pressure,  due 
to  dilatation  of  the  arterioles  and  veins  of  the  surfaces  of  the  body. 
The  pulse  is  faster.  The  dilatation  of  the  vessels  is  believed  to  be 
due  to  a  direct  action  on  the  muscular  fibers  of  the  vessels.  The 
rapid  pulse  is  due  to  depression  of  the  inhibitory  center  in  the 
medulla.  Large  doses  directly  weaken  and  slow  the  heart.  The 
faster  breathing  is  due  to  a  direct  action  on  the  respiratory  center  in 
the  medulla.  With  lethal  doses  the  respiration  becomes  shallower 
and  death  occurs  from  paralysis  of  this  center.  The  urine  is  slightly 
increased,  especially  if  the  renal  vessels  are  contracted,  as  in  cir- 
rhosis ;  but  if  normal  there  is  a  decrease  in  the  urine  from  relaxation 
of  the  pressure  in  the  renal  artery.  No  effect  is  exerted  on  the 
higher  cerebral  centers  except  indirectly  through  the  dilatation  of 
their  vessels.  Some  anomalies  of  sight  follow  large  doses.  Con- 
vulsions may  follow  toxic  doses.  The  temperature  is  lowered  to  an 
unimportant  extent.  The  blood  may  be  darkened  by  the  formation 
of  methemoglobin. 

Glonoin  is  partly  decomposed  in  the  blood,  and  partly  excreted 
by  the  kidneys. 

So  far  Cushny  conducts  us.  Shoemaker  says  glonoin  lessens  re- 
flex excitability,  retards  oxidation,  and  in  large  doses  stops  the 
heart  in  diastole. 

Therapeutics. — Brunton  introduced  the  nitrites  as  remedies  for 
angina  pectoris,  in  which  they  speedily  give  relief  by  relaxing  the 
spasm  of  the  arteries  and  relaxing  the  vascular  tension.  The  in- 
stantaneous relief  from  agonizing  pain  and  imminent  danger,  forms 
the  most  striking  exhibition  of  therapeutic  power  known.  In  other 
spasmodic  affections  this  remedy  acts  equally  well ;  and  it  has  well 
earned  the  designation  of  "the  life-saver."  The  paroxysm  of 
spasmodic  asthma  relaxes  at  once  after  a  few  granules  of  glonoin. 
In  the  case  of  renal  or  hepatic  colic,  due  to  the  passage  of  calculi,  a 
granule  of  glonoin  is  administered  with  one  each  of  atropine  and 
strychnine  arsenate,  to  open  the  bloodvessels  and  permit  a  speedier 
action  of  the  more  enduring  remedies.  The  pain  is  relieved  quickly 


GLONOIN  231 

by  glonoin  and  the  effect  is  prolonged  by  the  atropine.  In  many 
other  cases  glonoin  is  given  for  this  purpose  of  hastening  the  action 
of  other  remedies. 

In  cirrhotic  nephritis,  when  the  pulse  is  tense  and  small,  the 
heart  hypertrophied,  glonoin  has  been  given  with  the  best  results,  to 
relax  the  tension  and  obviate  the  dangers  arising  from  this  condi- 
tion. Here  there  has  been  observed  a  toleration  of  the  drug,  until 
in  one  instance  the  incredible  dose  of  six  grains  has  been  recorded. 
However,  as  this  is  a  remedy  whose  effects  are  evanescent  it  seems 
better  to  use  it  for  quick  effect  and  to  rely  upon  veratrine  to  keep 
up  a  continuous  depression  and  relaxation  of  the  circulation. 

On  the  heart  the  effect  needs  to  be  carefully  studied  that  the 
benefits  of  this  invaluable  remedy  may  be  secured  without  its 
dangers.  By  sending  the  blood  quickly  to  the  head  it  at  once  stops 
fainting,  syncopal  attacks ;  but  the  drop  in  vascular  tension  is 
perilous.  It  is  better  to  give  glonoin  with  brucine  which  acts 
quickly  enough  to  counteract  the  subsequent  depression.  In  obstruc- 
tive diseases  of  the  heart,  small  doses  of  glonoin  relieve  the  weak 
heart  by  relaxing  the  arterial  tension  and  thus  making  the  work 
easier.  But  as  the  effect  is  over  in  a  few  minutes  this  use  of  glonoin 
is  much  overrated.  Nor  when  given  with  digitalin  can  glonoin  be 
relied  upon  to  counteract  the  increase  of  vascular  tension  caused  by 
this  powerful  drug  (as  in  the  combination  of  glonoin,  digitalis, 
strophanthus  and  belladonna)  whose  effects  endure  for  days.  The 
prescription  attributed  to  Da  Costa  never  came  from  that  great 
therapeutist.  Here  also  veratrine  would  accomplish  the  indication 
far  better. 

It  has  been  advised  to  add  the  allied  agent  amyl  nitrite  to  chloro- 
form when  used  for  inhalation,  as  the  former  counteracts  the 
tendency  to  cerebral  anemia ;  but  the  same  objections  hold  good,  and 
the  result  can  not  fail  to  be  an  increase  of  the  danger. 

Headache  due  to  cerebral  anemia  is  relieved  momentarily  by 
glonoin  but  much  better  by  atropine. 

In  the  first  stage  of  an  epileptic  convulsion  the  condition  is  a 
cerebral  anemia,  and  this  may  be  instantly  removed  and  the  con- 
vulsion aborted  by  glonoin.  Add  atropine  to  prolong  the  effect,  and 
we  have  a  remedy  whose  efficiency  the  writer  has  proved  in  many 
cases.  Sometimes  the  convulsive  tendency  is  too  strong  to  be  per- 
manently postponed  in  this  way,  but  in  others  the  patient  has  kept 
the  fits  away  for  months  by  resorting  to  the  remedy  whenever  the 


232  GLONOIN 

impulse  to  a  spasm  is  felt.  Time  is  given  for  etiologic  treatment, 
while  the  striking  effects  of  the  glonoin  aid  in  breaking  up  the  habit. 

Glonoin  has  been  advised  to  relieve  the  craving  of  the  habitue 
for  opiates;  as  a  remedy  for  morphine  poisoning;  in  Raynaud's  dis- 
ease— where  also  the  writer  has  used  it  with  benefit  and  substituted 
veratrine  with  much  more — and  for  poisoning  from  illuminat- 
ing gas. 

Shoemaker  cautions  against  tablets  of  too  great  strength  as 
liable  to  explode. 

In  the  alleged  sunstroke  that  is  really  heat  exhaustion,  with  re- 
laxation, feeble  pulse  and  syncope,  the  best  treatment  is  by  glonoin, 
atropine  and  brucine,  administered  intensively. 

Ellingwood  says  glonoin  has  controlled  many  cases  of  post- 
partum  hemorrhage.  He  speaks  of  giving  it  hypodermically  in  cases 
of  drowning,  gas  poisoning,  and  opium  poisoning  with  uremic 
symptoms ;  it  has  caused  relaxation  in  tetanus ;  and  in  pallor  with 
palpitation. 

Bartholow  recommended  glonoin  to.  ward  off  the  chill  of  ague. 

Dr.  M.  G.  Price,  of  Mosheim,  Tenn.,  finds  glonoin  very  effective 
in  gastralgia  of  adults  and  of  children ;  in  eclampsia  with  high 
tension  this  is  abated  by  it;  in  dangerous  collapse  and  syncope  this 
is  above  all  the  remedy. 

Abbott  says  glonoin  relieves  congestion.  He  advises  it  in  high 
temperatures  with  pale  skin. 

Dr.  S.  J.  Smith  with  glonoin  saved  the  life  of  a  man  who  was 
poisoned  by  aconite. 

Dr.  A.  H.  R.  Ginley  gave  glonoin  to  a  child  with  cyanosis 
neonatorum  for  two  weeks,  finally  saving  its  life. 

Dr.  D.  S.  Ross  reports  the  case  of  a  man  84  years  old,  uncon- 
scious from  the  onset  of  pneumonia.  He  regained  consciousness 
with  glonoin  and  recovered. 

Dr.  J.  F.  Brenckle  reports  a  case  of  a  woman  two  weeks  over 
confinement,  seized  with  gastralgia  and  dyspnea,  with  weak  rapid 
pulse.  She  was  almost  immediately  relieved  by  glonoin  and  strych- 
nine and  digitalin.  Pericarditis  with  effusion  was  present. 

Dr.  R.  V.  Pearce  records  what  was  really  a  case  of  glonoin 
habit,  the  patient  taking  it  under  the  mistaken  idea  that  it  was  neces- 
sary as  a  heart  tonic. 

Dr.  W.  O.  Hamilton  used  glonoin  in  an  infant  with  opium 
poisoning,  with  success  when  amyl  nitrite  had  failed ;  also  in 


GOLD  233 

asphyxia   from   hypertrophied   tonsils,   malarial   chills,   emphysema, 
syncope  with  hourglass  contraction  in  abortion. 

The  granules  of  glonoin  are  too  strong.  Many  persons  like  the 
writer  cannot  take  gr.  1-250  without  disagreeable  effects.  A  dose 
of  gr.  1-500  would  be  preferable.  This  should  be  given  every  five 
minutes,  or  several  granules  at  once1 — always  crushed — in  emer- 
gencies. Flushing  of  the  face  or  a  sense  of  fullness  of  the  head,  are 
indications  of  full  therapeutic  effect,  when  the  remedy  should  be 
suspended. 

GOLD. 

Standard  granules — Gold  bromide,  gr.  1-67,  gm.  .001 ;  gold  chloride,  gr. 
1-67,  gm.  .001 ;  gold  and  sodium  chloride,  gr.  1-50;  gold  and  sodium  chloride, 
gr.  1-20. 

The  effects  of  gold  closely  resemble  those  of  mercury.  The 
action  is  slower  in  being  produced  when  given  in  medicinal  doses 
but  the  effects  are  more  lasting.  In  a  case  of  salivation  from  gold 
the  writer  was  months  in  getting  the  affection  under  control. 

Gold  has  bactericidal  powers  even  superior  to  those  of  mercury. 
Especially  are  these  shown,  against  the  tubercle  bacillus  (Shurley 
and  Gibbes).  It  increases  the  secretions  and  excretions  in  general, 
as  does  mercury,  and  stimulates  metabolism.  The  vital  processes 
are  quickened  universally,  the  red  cells  and  hemoglobin  increased, 
and  a  rise  of  temperature  caused.  Like  corrosive  sublimate  the  salts 
of  gold  are  corrosive  when  concentrated,  and  cause  vomiting,  diar- 
rhea, and  similar  evidences  of  gastrointestinal  irritation.  The  urine 
is  increased,  and  too  large  doses  cause  renal  hyperemia  and  albu- 
minuria.  The  property  of  increasing  the  sexual  appetite  and  powers 
in  both  sexes  has  been  attributed  to  gold,  but  if  true  this  effect  is 
pathologic.  Here  too  the  effect  parallels  that  of  mercury. 

Gold  is  eliminated  by  the  kidneys,  the  liver  and  the  bowels. 

Therapeutics. — Gold  bromide  has  been  tried  largely  as  a  sub- 
stitute for  the  big-dose  bromides  in  epilepsy.  There  is  a  bromide 
effect  obtained  from  the  gold  that  is  truly  remarkable  when  one  con- 
siders the  minute  quantity  of  bromine  in  it ;  but  it  is  better  as  an 
adjuvant  than  a  substitute.  Give  sodium  bromide  till  evidences  of 
bromism  appear,  then  add  the  bromides  of  gold,  arsenic  and  nickel 
successively,  and  excellent  results  are  obtained.  Care  must  be  had 
in  pushing  this  remedy  to  toleration,  as  the  salivation  is  not  indicated 
by  tender  teeth  as  with  mercury.  Auric  fever  and  gastric  disorders 
are  caused  by  the  overdoses.  Thus  employed,  the  bromide  treatment 


234  GOLD 

is  a  valuable  auxiliary  to  the  rational  methods  indicated  in  this  dis- 
ease. 

Shoemaker  credits  gold  with  a  valuable  action  in  atonic  dys- 
pepsia, nervous  dyspepsia,  gastric  catarrh,  torpid  liver,  etc. ;  but  in 
all  these  there  is  no  evidence  to  show  any  advantage  over  mercury, 
which  is  cheaper,  easier  to  obtain  and  to  handle.  In  the  early  stages 
of  cirrhosis  gold  has  been  given  with  asserted  advantage.  As  cir- 
rhosis means  a  destruction  of  gland  cells  and  replacing  them  with 
connective  tissue,  it  cannot  be  supposed  that  any  remedy  can  renew 
the  lost  tissue.  But  if  there  is  enough  gland  tissue  remaining  to  keep 
the  patient  alive  today,  it  should  suffice  for  tomorrow;  if  only  the 
cirrhotic  process  be  stayed.  And  possibly  gold  may  contribute  to 
this  end.  At  any  -rate  it  has  been  largely  given  in  cirrhosis  of  the 
liver  and  of  the  kidney,  with  asserted  advantage ;  and  Culbertson 
reported  relief  of  albuminuric  retinitis  from  this  remedy. 

Gold  has  been  used  for  arteriosclerosis,  the  vertigo  of  the  aged 
dependent  thereon,  and  for  that  due  to  indigestion.  The  iodide  of 
arsenic  has  proved  very  useful  in  these  cases  and  the  iodide  of  gold 
would  probably  be  still  better. 

Gold  has  been  advocated  in  whooping-cough,  laryngismus 
stridulus,  hysteria  and  in  functional  impotence.  It  is  useful  in 
amenorrhea  and  dysmenorrhea  due  to  deficient  innervation,  and  as  a 
preventive  of  abortion,  as  mercury  is  in  similar  cases.  From  the 
physiologic  action  Shoemaker  deduces  its  value  in  spinal  sclerosis, 
premature  senility,  depression  and  hypochondria,  neurasthenia, 
progressive  general  paralysis,  utero-ovarian  congestion,  menor- 
rhagia,  subacute  metritis,  nymphomania  and  spermatorrhea.  Better 
based  is  Strahan's  recommendation  of  this  metal  in  cerebral  anemia. 

Sometimes  syphilitics  cannot  bear  mercury  and  gold  will  take 
its  place.  We  believe  the  effects  are  rather  more  enduring,  but  it 
is  only  in  exceptional  cases  that  the  more  costly  metal  in  indicated. 
It  is  usually  given  in  tertiary  forms. 

Robinson  found  gold  cured  two  cases  of  diabetes  mellitus ; 
and  many  subsequent  cures  have  been  claimed  from  various  salts 
of  this  metal. 

Lydston  reported  success  in  treating  pyelitis  with  gold  hypo- 
dermically. 

Calmette  says  the  venom  of  the  cobra  may  be  antidoted  by  in- 
jecting a  one  per  cent  solution  of  gold  chloride,  2.  to  2,^/2  drams,  into 
and  about  the  wound,  not  more  than  15  minims  at  one  spot.  The 
solution  may  be  thrown  into  the  connective  or  the  muscular  tissue. 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


GOSSYPIN  235 

Injections  are  also  made  at  the  ligature  about  the  limb,  and  above  it. 
When  done,  the  ligature  may  be  removed. 

Shurley  and  Gibbes  reported  success  in  treating  tubercular 
phthisis  with  hypodermics  of  gold  and  sodium  gr.  1-20  to  1-6  for 
several  months. 

Reviewing  the  evidence  in  regard  to  gold,  we  are  unable  to  find 
positive  proof  of  its  utility  in  any  malady  except  syphilis :  though  it 
may  be  useful,  and  is  surely  deserving  of  trial,  in  tuberculosis,  cir- 
rhosis, and  injected  locally  in  cancer  and  lupus. 

The  dose  of  any  of  the  salts  is  the  same  as  of  corrosive  sub- 
limate— gr.  1-67  to  1-6  up  to  the  appearance  of  evidences  of  ap- 
proaching salivation. 

GOSSYPIN. 
Standard  granule — Gr.  1-6.  gin.  .01. 

Gossypin  is  a  concentration  from  the  bark  of  the  cotton  root, 
Gossypium  herbaceum.  The  virtues  appear  to  reside  in  an  acid 
resin. 

Cotton  root  is  an  emmenagog,  and  was  used  by  southern  slaves 
as  an  abortifacient.  It  has  the  repute  of  acting  much  less  acridly 
than  ergot  and  without  much  general  disturbance.  Felter  and 
Lloyd  recommend  it  in  uterine  inertia,  chlorosis  with  amenorrhea 
or  dysmenorrhea,  etc.  It  has  been  praised  in  hysteria,  anemia  of  the 
sexual  apparatus  with  lack  of  desire  and  pleasure;  also  for  im- 
potence, subinvolution  and  uterine  fibroids,  but  is  not  to  be  used  if 
there  is  irritation  or  tendency  to  inflammation.  It  is  a  stimulant 
diuretic. 

Specific  Indications. — Uterine  inertia  during  parturition ;  menses 
delayed  with  backache  and  dragging  pelvic  pain:  fullness  and 
weight  in  bladder,  with  difficult  micturition ;  hysteria  with  anemia  of 
genitals,  sexual  lassitude. 

Ellingwood  pronounces  gossypium  of  value  in  suppression  of 
the  menses  from  whatever  cause;  producing  firm,  regular  and 
strong  uterine  contractions.  It  is  a  hemostatic  of  some  power,  for 
uterine  fibroids  and  incipient  cancer;  valuable  in  menorrhagia  and 
metrorrhagia. 

Phillips  found  cotton  root  useful  in  hemoptysis.  It  has  been 
used  in  the  West  Indies  for  dysentery,  and  Poteyenke  employed  it 
as  a  general  hemostatic.  especially  in  a  peculiar  epistaxis  which  had 
resisted  other  remedies. 


236  GREGORY'S    SALT.     GUARANINE 

The  writer's  uses  of  gossypium  have  been  disappointing.  Pos- 
sibly the  fresh  plant  contains  virtues  not  present  in  the  preparations 
of  the  pharmacy. 


GREGORY'S    SALT. 

Standard  granule — Gr.   1-67,  gm.  .001. 

Gregory,  of  Edinburgh,  gave  a  process  for  the  extraction  of 
morphine,  which  consisted  in  precipitating  by  calcium  chloride,  a 
concentrated  solution  of  opium ;  an  insoluble  meconate  of  lime 
formed,  and  the  chlorate  of  morphine  remained  in  solution ;  which 
was  crystallized  by  concentration.  Robiquet  found  that  the  product 
did  not  correspond  with  the  chlorate  as  indicated  by  reaction,  and 
suspecting  that  the  salt  was  impure,  he  isolated  the  morphine  by 
means  of  ammonia,  and  obtained  with  potassa  a  new  precipitate, 
soluble  in  ether  and  crystallizing  admirably  in  presence  of  water. 
This  proved  to  be  codeine,  and  the  salt  procured  by  Gregory  a  mix?- 
ture  of  the  chlorates  of  morphine  and  of  codeine. 

This  salt  has  been  used  by  the  French  dosimetrists  to  some  ex- 
tent, and  is  preferred  to  morphine.  In  America  codeine  itself  has 
largely  replaced  morphine  as  a  remedy  for  coughs,  and  there  seems 
little  space  for  Gregory's  salt.  Possibly  it  may  answer  to  throw 
some  too  wise  patient  off  the  track,  as  the  older  physicians  were 
accustomed  to  do  when  they  prescribed  Aquila  alba,  or  Panchyma- 
gogus  que  roetanus  for  calomel.  Gregory's  salt  is  about  half  the 
strength  of  morphine,  but  is  obviously  subject  to  the  variability  of 
opium  itself,  as  to  the  relative  proportions  and  actual  amount  pres- 
ent of  each. 


GTJARANINE. 

Standard  granule — Gr.  1-67,  gm.  .001. 

Guaranine  is  an  alkaloid  obtained  from  the  Paullinia  sorbilis,  a 
plant  found  in  Brazil.  The  alkaloid  is  practically  identical  with 
caffeine,  containing  a  small  proportion  of  theobromine  in  addition. 
The  action  and  therapeutic  applications  are  the  same  as  with  caf- 
feine, and  to  detail  them  here  would  be  a  useless  repetition.  The 
presence  of  theobromine  may  render  guaranine  slightly  more 
diuretic. 


HAMAMELIN  237 

/ 

HAMAMELIN. 

Standard  granule — Gr.  1-6,  gm.  .01. 

Hamamelin  is  a  concentration  from  Hamamelis  Virginiana,  the 
witch-hazel.  No  glucoside  or  alkaloid  has  been  obtained  from 
hamamelis,  which  contains  tannic  and  gallic  acid,  and  a  volatile  oil. 

Felter  and  Lloyd  term  witch-hazel  tonic  and  astringent.  They 
speak  of  its  use  in  hemorrhages,  diarrhea,  dysentery,  excessive  mu- 
cous discharges  with  full,  pale  relaxed  tissues ;  in  incipient  phthisis ; 
as  a  local  application  for  painful  swellings  and  tumors,  sore  mouth, 
external  inflammations,  prolapsus  ani  and  uteri,  leucorrhea,  gleet 
and  ophthalmia.  Its  most  pronounced  virtue  is  in  affections  of  the 
veins,  its  tonic  action  being  markedly  shown  in  varicosities,  hemor- 
rhoids and  hemorrhages.  The  parts  are  usually  pale  and  relaxed, 
though  sometimes  the  deep  red  of  venous  engorgement  is  seen.  It 
is  adapted  to  the  whole  venous  system. 

Scudder  and  others  have  found  it  a  valuable  remedy  in  passive 
hemorrhages  and  congestions,  epistaxis,  hemorrhoids,  phlegmasia 
dolens  after  the  acute  phases,  phlebitis  and  varicose  veins ;  diarrhea, 
chronic  pharyngitis,  chronic  uterine  congestion,  where  the  cervix 
is  enlarged  without  abnormal  hardness;  the  os  soft,  open  with 
leucorrhea  and  prolapsus  possibly;  diarrhea  with  passive  hemor- 
rhage ;  chronic  vascular  conditions  of  mucous  tissues,  and  old  flabby 
ulcers.  Howe  gave  hamamelis  in  uterine  hemorrhages  with  suc- 
cess; in  menorrhagia  and  bleeding  after  abortion  no  other  remedy 
did  as  well ;  in  postpartum  cases  it  is  not  equal  to  ergot ;  it  is  valua- 
ble in  chronic  diarrhea  and  in  cholera  infantum ;  arrests  oozing  of 
blood  from  mucosa,  and  in  non-inflammatory  hematuria.  It  is  often 
of  value  in  renal  affections  due  chiefly  to  vascular  relaxation; 
diabetes  insipidus,  mucous  profluvia  of  the  urinary  tract,  vesical 
catarrh,  and  irritation  of  the  bladder  from  varicocele.  In  female 
disorders  it  is  indicated  by  venous  fullness  and  relaxation ;  dull  ach- 
ing ovarian  pains;  leucorrhea  with  fullness  of  the  pelvic  veins  and 
relaxation  of  the  utero-vaginal  walls ;  ovarian  and  testicular  conges- 
tion; ocular  and  conjunctival  hemorrhages;  sprains,  contusions, 
wounds,  with  Asepsin  as  a  dressing  for  small  wounds;  with  hy- 
drastis  for  irritation  of  the  external  auditory  meatus ;  chafing ;  dif- 
fuse cutaneous  inflammation ;  stibacute  sore  throat ;  scarlatinal 
angina ;  tonsillitis,  phlegmon  of  throat,  diphtheria,  acute  pharyngitis, 
chronic  conjunctivitis  with  vascular  lids;  mastitis;  soreness  of  ab- 
dominal muscles  after  childbirth;  muscular  soreness  and  aching 
from  any  cause;  tan,  freckles,  sunburn,  dilated  facial  capillaries,  as 


238  HELENIN 

a  wash  after  shaving;  an  injection  for  gonorrhea;  an  ointment  for 
piles. 

Specific  Indications. — Venous  debility  with  relaxation  and  full- 
ness ;  pale  mucosa — or  deep  red  or  blue  from  venous  engorgement 
or  stasis — mucous  flow  with  venous  fullness ;  passive  hemorrhages, 
varicoses,  capillary  stases,  hemorrhoids  with  sense  of  fullness ;  re- 
laxed and  sore  throat ;  dull  ache  in  rectum,  pelvis  or  female  genitals ; 
perineal  relaxation  with  fullness ;  muscular  relaxation,  soreness, 
aching  or  bruised  feeling;  from  cold,  exposure,  injury,  strain  or 
physical  exertion. 

Ellingwood  says  hamamelis  is  useful  for  bleeding  from  a  tooth 
cavity,  from  the  posterior  nares,  or  from  spongy  gums ;  quickly 
cures  acute  hemorrhoids  and  with  collinsonia  greatly  benefits 
chronic  cases ;  and  gives  prompt  relief  to  burns  and  scalds. 

In  all  cases  where  possible  this  remedy  should  be  given  internally 
and  applied  locally  at  the  same  time.  The  specific  virtues  probably 
reside  in  the  volatile  oil,  and  are  lost  in  the  galenic  preparations, 
which  owe  whatever  value  they  ,may  possess  to  the  tannic  acid 
present.  As  to  the  indications — the  whole  story  is  told  in  the  two 
words :  Relaxed  veins. 

Hamamelin  may  be  given  in  doses  of  gr.  1-6  to  2.  every  hour 
or  two. 

HELENIN. 

Standard  granules — Gr.  1-67,  gm.  .001 ;  gr.  1-6,  gm.  .01. 

The  introduction  of  alkaloidal  medication  will  undoubtedly  result 
in  the  rescue  from  neglect  of  some  remedies  formerly  prized,  but 
which  have  fallen  into  disuse  from  the  uncertainty  attending  the 
use  of  the  old  preparations.  Among  these  is  elecampane,  so  highly 
valued  once  that  there  must  have  been  some  reason  for  its  popularity. 

Alant-camphor  (helenin),  is  a  yellow,  hard  mass,  obtained  by 
steam  distillation  from  the  root  of  Inula  helenium.  Recent  in- 
vestigations prove  this  substance  to  be  a  mixture  of  a  fluid  and  a 
crystallizable  substance,  which  can  be  separated  by  pressing  between 
blotting  paper. 

Helenin  is  the  name  given  also  to  a  stearopten,  obtained  as  a  by- 
product with  alantol  by  mixing  water  with  the  alcoholic  extract  of 
the  root,  and  repeated  recrystallization  of  the  precipitate.  This 
forms  large,  colorless,  loose,  bulky  needles,  melting  at  231.2  F., 
almost  insoluble  in  water,  easily  so  in  alcohol,  ether  and  oils.  It  is 
not  volatile  unless  decomposed.  It  does  not  form  salts  with  acids 
or  alkalies  but  is  decomposed  by  them. 


HELENIN  239 

Physiologic  Action. — In  doses  of  o.oi — 0.05  many  times  daily,  in 
health,  helenin  produces  no  notable  effect'.  One  part  suffices  to 
prevent  putrid  decomposition  in  10,000  parts  of  urine  (Korab). 
The  local  application  if  too  long  continued  causes  erythema. 

This  agent  acts  primarily  on  the  mucosa,  especially  of  the  res- 
piratory organs,  on  the  lymphatics  and  the  glands.  It  renews  the 
functional  activity  of  these  organs  and  gives  new  energy  to  the 
tissues,  as  shown  by  improved  secretions.  Having  entered  the 
fluids  it  favors  vegetative  metamorphosis,  liquefying  and  dissipat- 
ing exudates — a  quality  that  explains  the  curative  action  in  specific 
dyscrasias  (Van  Renterghem). 

Therapeutics. — It  is  a  stimulant  to  the  digestive  organs,  the  cir- 
culation and  the  principal  secretions.  Larger  doses  cause  nausea 
and  vomiting.  It  is  then  a  tonic  aromatic,  with  expectorant, 
diuretic  and  diaphoretic  properties.  This  remedy  may  be  utilized 
in  atonic  dyspepsia,  general  debility,  torpid  dysmenorrhea,  pulmo- 
nary and  bronchial  catarrhs,  exanthematic  fevers  with  retarded 
eruptions,  and  even  in  the  depression  following  the  introduction  of 
a  poison  or  venom  (Gubler). 

Huesemann  speaks  of  its  local  use  for  pruritus-. 

Knakstedt  pronounced  it  very  efficacious  against  eczema  and 
other  skin  affections,  especially  the  itch ;  applied  locally  and  taken 
internally. 

Valenzuela,  Korab,  Blocq  and  others,  publish  accounts  little 
short  of  miraculous,  of  the  effects  of  helenin  on  respiratory  maladies, 
and  as  an  antiseptic  in  dressing  wounds.  In  tuberculous  and  other 
forms  of  pulmonary  phthisis,  chronic  bronchopneumonia  and  whoop- 
ing-cough, it  gave  good  results.  One  chronic  bronchopneumonic, 
aged  46,  had  for  eight  months  resisted  all  treatment.  He  was  given 
helenin,  gtt.  v — x  daily,  and  was  cured  in  fifteen  days.  A  consump- 
tive, aged  36,  with  tuberculous  foci  in  both  lungs,  hemoptysis,  etc., 
took  helenin  o.oi  ten  times  a  day  for  two  weeks,  with  rapid  im- 
provement, and  both  lungs  became  permeable.  In  all  cases  improve- 
ment resulted.  In  chronic  bronchitis  the  cure  nearly  always  proved 
complete. 

In  whooping-cough  the  efficacy  of  helenin  is  termed  marvelous, 
every  case  resulting  in  a  cure  surprisingly  rapid.  The  drug  was 
given  internally.  Simultaneous  inhalations  of  helenin  gave  no  ad- 
vantage. The  cough  always  remitted,  as  well  as  the  dyspnea  and 
thoracic  pains,  all  ceasing  completely,  without  the  least  sign  of 


240  HELONIN 

narcotism.  The  sputa  lessened  and  became  gelatinous,  an  effect  so 
special  that  it  could  not  fail  to  attract  attention. 

On  the  digestive  tract  helenin  exerts  a  very  marked  tonic  action, 
increasing  appetite  and  aiding  digestion,  even  in  phthisics  with  un- 
conquerable anorexia. 

Commenting  on  these  glowing  accounts,  Van  Renterghem  de- 
scribes the  case  of  a  lady,  with  chronic  laryngitis  and  acute  exacer- 
bations. She  improved  under  other  treatment  but  the  hoarseness 
persisted,  with  incessant  cough.  He  gave  her  helenin  o.oi  every 
hour.  By  the  second  day  she  had  improved,  and  a  cure  resulted 
within  two  weeks. 

In  another  case,  spasmodic  asthma,  chloro-anemia  and  bronchitis, 
with  evening  fever,  cough,  debility,  green  purulent  sputa  and 
anorexia,  helenin  was  given,  o.oi  every  hour ;  with  strychnine 
0.0005,  quassin  o.ooi,  sodium  arsenate  o.ooi,  four  granules  each 
before  meals ;  and  daturine  a  granule  every  half-hour  till  effect,  to 
cut  the  asthmatic  attack.  The  treatment  was  crowned  with  success, 
all  symptoms  disappearing  within  three  weeks. 

Helenin  is  a  remedy  with  a  future.  Its  special  action  on  the 
respiratory  mucosa  indicates  its  elimination  by  the  lungs.  The  in- 
efficiency of  the  inhalation  of  helenin  indicates  that,  like  arbutin,  it 
is  transformed  in  the  body.  Though  not  a  specific  for  all  pulmonary 
maladies,  helenin  is  still  a  very  valuable  acquisition,  in  all  forms  of 
chronic  bronchitis,  simple  or  diathetic ;  in  chronic  lobular  pneumonia  ; 
and  in  whooping-cough.  This  list  may  be  extended  by  further 
essays  of  the  remedy. 

Merck  says  alantol  is  an  internal  antiseptic  and  anticatarrhal ; 
used  in  pulmonary  tuberculosis  instead  of  turpentine.  Dose  o.oi, 
t.  i.  d. 

As  helenin  does  not  exert  any  evident  action  in  health  no  indi- 
cation of  physiologic  effect  can  be  given.  The  usual  dose  is  o.oi 
(gr.  1-6)  every  one  to  two  waking  hours.  Elecampane  formerly 
had  a  reputation  as  a  remedy  for  snake  bites  and  other  poisonous 
wounds,  but  no  recent  essay  of  its  virtues  has  been  recorded. 

HELONIN. 

Standard  granule — Gr.  1-6,  gm.  .01. 

Helonin  is  a  concentration  from  Helonias  dioica. 

This  plant  contains  a  neutral  principle  soluble  in  alcohol  and 
water,  whose  properties  have  not  yet  been  studied,  further  than  that 
it  is  said  to  act  as  a  "heart  poison." 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


HYDRASTINE  241 

The  American  Dispensatory  gives  the  following  information: 

Helonias  is  tonic,  diuretic  and  vermifuge,  in  large  doses  emetic 
and  when  fresh  sialagog.  It  has  proved  useful  in  dyspepsia, 
anorexia,  and  to  remove  worms;  indigestion,  and  malassimilation 
due  to  disease  or  reflex  from  the  female  genitals ;  chlorosis  from  the 
same  cause ;  the  gastric  symptoms  of  nephritis ;  colic,  genital  atony, 
nocturnal  emissions  from  excess,  with  impaired  memory  and  apathy ; 
general  weakness  and  dull  renal  or  lumbosacral  pain ;  as  a  uterine 
tonic  in  amenorrhea,  dysmenorrhea,  leucorrhea  and  to  remove  the 
tendency  to  repeated  miscarriages;  it  relieves  the  irritability  and 
despondency  attending  uterine  disease;  dysmenorrhea  with  pelvic 
distention,  the  womb  feeling  as  if  ready  to  fall  out  of  the  body  and 
aching;  best  here  in  small  doses;  vomiting  of  pregnancy;  diabetes 
insipidus ;  distinctively  a  uterine  tonic. 

Specific  Indications. — Mental  irritability  and  despondency, 
sexual  lassitude,  atony  of  female  reproductive  organs;  gastric  de- 
bility, anorexia,  nausea,  indigestion  and  malassimilation  when  due 
to  uterine  reflexes ;  sticky,  slimy  leucorrhea,  atony  of  urinary  tract, 
dysmenorrhea  with  pelvic  fullness  and  heaviness,  bearing  down  as 
if  parts  would  fall  out. 

Ellingwood  pronounces  it  a  liver  remedy  of  rare  value;  for 
dragging  and  weight  in  the  male  bladder ;  quickly  overcomes  phos- 
phaturia;  useful  in  nephritis. 

It  is  to  be  regretted  that  the  members  of  this  valuable  group  of 
vegetable  uterine  tonics  have  only  been  presented  to  the  profession 
in  mixtures  and  combinations,  so  that  the  specific  virtues  of  helonias, 
aletrin,  mitchellia,  dioviburnin,  senecionin,  and  others  have  not  been 
made  out.  The  only  attempt  at  such  a  differentiation  yet  made  is 
by  the  eclectics ;  and  as  this  is  directly  in  line  with  our  efforts  at  ac- 
curate medication,  we  have  given  the  specific  directions  for  the  uses 
of  each  of  these  remedies  as  laid  down  by  the  leaders  of  this  school. 
Follow  these  until  your  own  observations  have  given  you  a  better 
guide. 

The  dose  of  helonin  is  gr.  1-6  every  two  to  four  hours  in  most 
cases ;  gr.  I  four  times  a  day  when  smaller  doses  fail. 

HYDRASTINE. 

Standard  granules— Hydrastin,  j?r.  1-6,  gm.  .01;  hydrastine,  gr.  1-67, 
gm  .001. 

Hydrastin  is  a  concentration  from  Hydrastis  Canadensis,  and 
contains  the  combined  alkaloids,  hydrastine,  berberine  and  canadine. 


242  HYDRASTINE 

Hydrastine  is  an  alkaloid  from  the   same   source  as  hydrastin. 

Hydrastine  is  soluble  in  water  sparingly  unless  acidulated;  in 
alcohol,  ether  and  chloroform.  Large  doses  slow  the  pulse  and  still 
larger  ones  cause  weakness,  tremors,  dyspnea  and  incoordination. 
Very  large  doses  induce  clonic  and  then  tonic  convulsions  and 
tetanus,  during  which  respiration  ceases  (Cushny).  The  pulse 
slows  at  first  from  stimulation  of  the  vagus  center,  then  quickens  as 
it  is  paralyzed,  and  later  again  slows  from  a  direct  action  on  the 
heart  muscle.  The  vascular  pressure  rises  from  contraction  of  the 
arterioles,  then  falls  from  their  relaxation  and  the  weakening  of  the 
heart.  The  vasomoter  center  in  the  medulla  is  directly  stimulated. 
Cushny  questions  the  asserted  action  of  hydrastine  upon  the  uterine 
fibers,  and  that  upon  the  liver.  The  respiration  is  at  first  faster,  and 
besides  its  action  on  the  centers  it  weakens  and  paralyzes  muscular 
fiber  of  the  heart.  This  effect  resembles  that  of  thebaine.  Hy- 
drastine is  excreted  by  the  kidneys.  A  cumulative  action  has  been 
observed.  Death  from  lethal  doses  is  due  to  heart  paralysis. 

Some  diuretic  action  is  exerted. 

Therapeutics. — Hydrastin  has  long  been  used  as  a  bitter  tonic. 
It  is  an  astringent,  gradually  reducing  redundant  secretions.  It  has 
been  employed  as  an  injection  in  gonorrhea,  vaginitis  and  leucor- 
rhea,  and  given  internally.  For  various  forms  of  stomatitis, 
syphilitic,  mercurial  and  digestive,  it  is  an  efficient  lotion.  Many 
other  applications  of  this  valuable  astringent  are  made,  such  as  a 
lotion  to  ulcers,  fissured  nipples,  otorrhea,  pharyngitis,  and  any  skin 
disease  with  secretion  to  be  dried  up.  Shoemaker  recommended 
ointments  in  bromidrosis,  carcinoma,  etc. 

Unhealthy  ulcers,  chancroids  and  sloughing  sores  are  benefited 
by  this  application.  Internally  hydrastin  has  been  used  with  benefit 
in  gastric  and  duodenal  catarrhs,  especially  of  drunkards,  their 
morning  vomiting,  jaundice,  and  enteritis,  all  of  the  chronic  type. 
It  checks  the  loss  of  albumin  is  desquamative  nephritis.  As  a 
hemostatic  it  has  succeeded  when  ergot  failed;  in  bleeding  piles, 
hemoptysis — where  Marini  pronounced  it  the  best  hemostatic — and 
for  the  hemorrhage  of  uterine  fibromas. 

As  an  oxytocic  he  found  it  less  prompt  than  quinine  but  hasten- 
ing labor  and  preventing  hemorrhages  when  given  for  a  week  be- 
fore confinement. 

Kruse  urged  hydrastin  for  night-sweats,  a  full  dose  at  bedtime. 
Others  have  confirmed  this  recommendation,  in  phthisis  and  other 
forms  of  free  sweating. 


HYDRASTINE  243 

/ 

The  eclectic  applications  of  hydrastis,  as  given  in  King's  Dis- 
pensatory are  numerous:  The  chief  action  is  exerted  upon  the 
mucous  and  glandular  structures,  and  through  the  hydrastine,  upon 
the  nervous  system  to  some  extent.  It  is  valuable  in  disorders  of 
digestion,  functional,  subacute  and  atonic  with  mucous  flux;  de- 
bility of  mucosa;  aphthous  stomatitis,  gastric  irritability,  icewater 
dyspepsia,  gastric  catarrh  and  ulcer,  the  best  substitute  for  alcohol 
when  stopping  the  use  of  the  latter,  with  capsicum  and  strychnine ; 
belching  of  putrescent  gas,  with  sense  of  "goneness,"  preferring 
hydrastine  in  minute  doses  if  there  is  great  irritability ;  catarrhs  of 
the  intestine  and  gall-ducts,  obstinate  constipation,  hepatic  obstruc- 
tion or  congestion;  convalescence  from  diarrhea  or  dysentery,  in 
children;  locally  for  fissured  anus,  hemorrhoids,  ulcers  and  eczema 
of  the  anus,  prolapsed  and  ulcerated  rectum ;  catarrhal,  follicular  or 
granular  pharyngitis;  syphilitic  ulcer  of  nose  or  pharynx,  sore 
throat,  rhinitis,  ulcerated  or  aphthous  tonsillar,  pharyngeal  or  retro- 
pharyngeal  catarrh;  subacute  nasopharyngeal  catarrh  where  the 
mucosa  are  dry  and  parched,  secretions  altered  in  quantity  and  char- 
acter; in  catarrhal  hypertrophy  with  profuse  discharge  and  thicken- 
ing of  the  membrane  it  has  no  equal;  when  mucus  drops  into  the 
throat  ditto;  use  locally  and  internally;  best  if  with  catarrhs  there 
is  muscular  debility;  follicular  and  simple  conjunctivitis,  corneal 
ulcer,  ciliary  blepharitis,  trachoma,  otitis  media  if  free  from  gran- 
ulations, eczema  of  the  auditory  meatus,  and  irritation  from  wax,  in 
all  which  it  is  used  locally;  myalgia,  when  worse  on  pressure  or 
motion  (Webster)  ;  often  reflexes  from  uterine,  rectal  and  prostatic 
disease ;  reflex  headaches  involving  the  scalp  muscles ;  pectoral 
tenderness  from  lacerated  cervix ;  muscular  pains  due  to  hemor- 
rhagic  anemia;  Schatz  found  it  useful  in  hemorrhage  from  uterine 
myomas,  congestive  dysmenorrhea,  hemorrhage  in  virgins  even 
after  curetting,  hemorrhage  from  subin volution,  metritis,  endome- 
tritis,  parametritis,  cicatrices,  stenoses,  and  climacteric.  He  pro- 
nounced it  too  slow  for  postpartum  hemorrhage,  but  good  for  pas- 
sive forms,  and  for  metrorrhagia.  It  is  like  ergot  useful  for  chronic 
cerebral  engorgements,  like  congestions.  It  has  been  advised  for 
fungoid  endometritis,  lacerated  cervix  and  pelvic  cellulitis;  leucor- 
rheas,  vaginal  and  uterine;  gonorrhea,  gleet,  with  thuja;  incipient 
stricture,  spermatorrhea  and  cystitis  even  with  ulceration  (King)  ; 
cervical  erosions  and  light  papillary  vegetations ;  scrotal  eczema, 
acne,  seborrhea  sicca  or  oleosa,  scrofula,  rosacea,  lupus,  sycosis, 
boils,  carbuncles  and  ulcers  (Jeanson)  when  dependent  on  gastric 


244  HYDRASTINE 

disturbance;  mitigates  the  severity  of  cancer,  retarding  progress;  in 
convalescence  from  maladies  with  excessive  mucous  fluxes  or 
hemorrhages ;  or  from  general  debility,  protracted  fevers,  inflamma- 
tions, and  nervous  prostration. 

Specific  Indications. — Non-acute  catarrhs,  and  acute  purulent 
otitis  media,  gastric  irritability;  irritation  of  parts  with  feeble  cir- 
culation ;  muscular  soreness  worse  on  motion  or  pressure ;  passive 
pelvic  hemorrhages ;  skin  diseases  depending  on  gastric  disease. 

Ellingwood  says  hydrastis  resembles  strychnine  but  its  influence 
is  more  slowly  developed  and  more  lasting;  it  stimulates  the 'respira- 
tion and  circulation,  imparting  tone  and  power  to  the  heart,  and  in- 
fluencing blood  stasis  like  ergot.  Muscular  tissue  everywhere  is 
thus  influenced.  It  inhibits  the  development  of  superfluous 
muscular  tissue.  It  increases  the  secretion  of  gastric  and  intestinal 
juices,  and  peristalsis.  In  cancer  of  the  breast  he  gives  hydrastis 
if  the  tumors  are  hard  and  painful,  conium  if  small,  hard  and  pain- 
less; phytolacca  if  soft  or  undulated,  tender,  with  pain  extending 
into  the  axilla.  None  of  these  is  valuable  if  open ;  all  must  be  long 
continued  and  applied  externally  also. 

The  text-books  give  the  toxic  actions  of  this  drug  and  say 
scarcely  anything  of  the  effects  of  medicinal  doses;  so  that  one 
would  draw  from  them  the  conclusion  that  it  was  unfit  for  remedial 
administration.  As  a  bitter  tonic  hydrastis  has  no  superior,  for  all 
the  uses  to  which  such  an  agent  may  be  applied.  The  uses  of  ber- 
berine  are  fully  described  in  another  chapter.  The  concentration 
should  be  dropped  out  of  use ;  and  whichever  of  the  alkaloids  is  In- 
dicated substituted. 

Hydrastine  may  be  ranked  with  the  strychnine  group,  and  El- 
lingwood's  differentiation  adopted.  The  writer  has  repeatedly  noted 
the  slowness  of  hydrastine  in  getting  to  work  and  the  singular  en- 
durance of  its  effects.  Its  property  of  giving  tone  to  unstriped 
muscular  fiber  renders  it  useful  in  both  constipation  and  diarrhea 
when  due  to  relaxation.  It  is  a  dryer  of  mucous  weeping.  It 
checks  hemorrhagic  oozing.  When  the  mucosa  are  worn  out  by 
long-continued  over-stimulation,  by  alcohol  or  condiments,  hydras- 
tine  will  do  more  than  any  other  remedy  to  restore  functional 
activity.  But  in  the  treatment  of  hemorrhages  it  has  been  replaced 
by  a  better  remedy,  in  hydrastinine. 

The  best  effects  of  hydrastine  are  obtained  from  small  doses 
long-continued.  Give  from  gr.  1-67  to  1-6  before  each  meal  and  at 
bedtime,  for  a  month  before  deciding  on  its  value. 


HYDRASTININE  245 

HYDRASTININE. 

Standard  granule — Gr.  1-12,  gm.  .005. 

Hydrastinine  is  an  artificial  alkaloid  formed  from  hydrastine. 
It  also  forms  in  the  plant  under  certain  conditions,  so  that  the 
galenic  preparations  of  hydrastis  usually  contain  some  of  this  agent. 

Hydrastinine  causes  little  disturbance  of  the  centers  of  motion 
and  sensation,  except  in  enormous  doses  (Santesson).  The  heart 
slows  through  stimulation  of  inhibition,  an  action  analogous  to  that 
of  aconitine.  The  arterial  tension  rises  further  than  after  hydras- 
tine,  and  this  effect  lasts  much  longer.  It  does  not  depress  'the  heart 
in  medicinal  doses.  Cushny  doubts  the  assertion  that  hydrastinine 
causes  rhythmic  contraction  of  the  uterus  and  abortion.  It  acts 
solely  on  the  uterine  vessels,  as  on  those  of  the  rest  of  the  body,  and 
may  cause  death  of  a  fetus  by  choking  off  its  blood-supply. 

Hydrastinine  is  soluble  in  alcohol,  ether  or  chloroform,  with  dif- 
ficulty in  hot  water,  but  its  salts  are  readily  soluble  in  water. 

Falk  concludes  that  hydrastinine  paralyzes  by  its  influence  on  the 
moter  sphere  of  the  spinal  cord ;  it  is  not  a  cardiac  poison ;  it  effects 
vascular  contraction  partly  by  exciting  the  vasomotor  centers  but 
mainly  by  a  direct  influence  on  the  blood-vessels.  The  rise  in 
vascular  pressure  is  great  and  persistent.  The  pulse  slows,  before 
death  the  pressure  falls  and  death  from  lethal  doses  is  due  to 
paralysis  of  the  center  of  respiration. 

As  compared  with  hydrastine,  hydrastinine  does  not  cause  spinal 
irritation  or  tetanus ;  has  no  injurious  local  effect ;  is  not  a  cardiac 
poison,  but  an  excitant,  and  death  can  be  prevented  by  artificial 
respiration ;  the  blood-pressure  is  much  greater,  has  no  interruptions 
of  relaxation,  and  is  the  result  of  a  steady  contraction  of  the  blood- 
vessels and  not  due  to  centric  irritation. 

Bunge  found  that  large  doses  reverse  the  effects  of  small  ones, 
by  paralyzing  the  vagus.  Hydrastinine  does  not  destroy  the  red 
blood  cells  in  any  doses,  large  or  small. 

Therapeutics. — The  action  of  this  agent  points  to  its  use  in  any 
affection  where  it  is  desirable  to  limit  the  afflux  of  blood  to  the  ab- 
dominal and  especially  the  pelvic  organs.  Permanent  benefits  are 
therefore  attained  in  congestive  dysmenorrhea,  virgins'  menor- 
rhagia  with  no  evident  lesion,  and  in  retrouterine  hematocele.  In 
endometritis  and  in  hemorrhages  from  disease  of  the  adnexa  it  gives 
temporary  relief.  It  palliates  the  hemorrhage  from  myomas  for  a 
long  time.  It  does  not  cause  contraction  of  the  uterine  muscular 


246  HYDRASTININE 

tissue  and  is  useless  in  postpartal  hemorrhages.  Nor  will  it  excite 
labor  pains  or  complete  expulsion  of  uterine  contents  at  or  before 
term.  It  is  therefore  not  a  substitute  for  ergot.  But  hydrastinine 
may  possibly  stop  the  hemorrhage  of  commencing  abortion  by 
astringing  the  bleeding  vessels,  and  here  it  is  safer  than  ergot. 

Hydrastinine  has  been  given  with  advantage  for  hemoptysis, 
continued  a  week  or  two  after  the  cessation  of  the  hemorrhage 
(Hausmann). 

Overdoses  have  been  followed  by  uterine  pains,  gastric  pain  and 
nausea,  pharyngitis,  and  rarely  indurations  or  ecchymoses  after  its 
hypodermic  administration. 

As  hydrastinine  lessens  the  irritability  of  the  motor  areas  of  the 
brain,  it  has  been  suggested  as  a  remedy  for  epilepsy  (Cushny). 

Keyser  found  hydrastinine,  gr.  3  to  an  ounce  of  glycerin,  use- 
ful as  a  local  application  for  granular  conjunctivitis.  Shoemaker 
lists  several  forms  of  skin  disease  in  which  he  uses  it  in  lotion  or 
ointment.  Rousse  pronounced  it  effective  in  uterine  hemorrhages, 
phthisical  night-sweats,  hemoptysis,  epilepsy  and  nephritis;  hemo- 
static  in  congestive  metrorrhagia,  menorrhagia,  after  parturition 
and  abortion,  hemorrhages  from  displacements  or  diseases  of  the 
adnexa,  and  during  pregnancy  and  labor;  useless  in  myomas  and 
cancer.  Hydrastinine  acts  quicker  than  cotarnine,  but  is  less  endur- 
ing. Hydrastinine  contracts  the  uterine  and  intestinal  vessels, 
cotarnine  dilates  them;  the  first  is  preferable  for  acute,  the  second 
for  chronic  maladies. 

Hydrastinine  increases  the  intestinal  peristalsis  and  the  move- 
ment of  bile.  It  may  be  employed  as  an  agent  to  restrain  mucous 
fluxes  when  not  acute.  Huchard  advises  hydrastinine  for  a  week 
preceding  menstruation  in  cases  of  metrorrhagia. 

The  dose  of  hydrastinine  is  from  ^  to  il/2  grains  a  day,  divided 
to  suit  the  case.  This  is  in  serious  hemorrhages ;  ordinary  cases  re- 
quire about  half  these  doses. 

Reviewing  the  data  available  on  the  salts  derived  from  hydrastis, 
it  seems  that  all  preparations  of  this  plant  might  be  abandoned  ex- 
cept berberine  and  hydrastinine.  The  latter  is  in  all  cases  for  which 
hydrastine  is  used  superior  to  it.  The  great  cost  of  hydrastinine  is 
the  chief  objection  to  its  extensive  employment;  and  unfortunately 
this  seems  likely  to  increase,  as  the  plant  is  being  extirpated  and 
grows  scarcer  every  year.  English  drug  journals  complain  that  the 
quality  of  the  drug  has  deteriorated  as  it  is  no  longer  gathered  by 
the  Indians,  and  less  care  is  taken  to  secure  it  at  the  season  of 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


HYOSCINE  HYDROBROMATE  247 

greatest  activity.  The  consequence  is  that  the  yield  of  alkaloids  is 
small  or  wanting — a  circumstance  which,  the  journal  quoted  naively 
remarks,  does  not  interest  the  preparer  of  galenic  preparations. 

HYOSCINE    HYDROBKOMATE. 

Standard  granule — Gr.  i-iooo,  gm.  .0000625. 

Hyoscine  was  discovered  by  Ladenburg  in  1880.  It  exists  in 
connection  with  atropine  in  varying  proportions  in  every  one  of 
the  mydriatic  group  of  plants,  but  in  none  does  it  predominate,  un- 
less in  exceptional  specimens.  For  the  rescue  of  this  admirable 
remedy  alkalometry  is  to  be  credited. 

Hyoscine  is  a  thick,  syrupy  liquid,  but  its  salts  crystallize.  The 
hydrobromate  is  used  by  preference.  It  is  readily  soluble  in  water. 

Physiologic  Action. — Hyoscine  resembles  atropine  in  its  effects 
upon  the  nerve  terminals.  The  accounts  of  its  action  differ  accord- 
ing to  the  purity  of  the  article  used.  The  pulse  is  slightly 
quickened,  and  the  pupil  dilated,  some  say  more  quickly  than 
by  atropine.  Instead  of  stimulating  the  cerebrum,  hyoscine  causes 
a  sense  of  fatigue  and  drowsiness  in  small  doses,  the  patient 
moving  and  speaking  less.  In  full  doses  sleep  is  produced,  some- 
times with  a  suddenness  that  is  striking.  The  writer  once  admin- 
istered a  hypodermic  of  hyoscine  gr.  i-ioo  to  a  patient,  and  then 
went  out  for  four  hours.  On  his  return  he  found  the  patient  stand- 
ing exactly  where  he  had  left  him,  at  the  foot  of  his  -bed,  simply  hav- 
ing changed  his  posture  by  stooping  over  it,  sound  asleep.  He  had 
never  moved.  The  sleep  from  hyoscine  closely  resembles  the 
normal;  the  patient  may  be  aroused  if  the  dose  is  not  toxic,  and 
awakes  refreshed. 

The  sleep  lasts  about  8  hours.  Sometimes  slight  confusion  or 
even  delirium  precedes  sleep.  When  the  symptoms  of  atropine  fol- 
low the  use  of  hyoscine  there  has  probably  been  a  decomposition 
into  the  former.  But  after  full  doses  of  the  purest  hyoscine, 
atropine  symptoms  are  apt  to  follow. 

Occasionally  collapse  has  followed  hyoscine.  The  blood  pres- 
sure falls,  and  respiration  slows.  Cushny  says  that  tolerance  is 
pt  oduced  by  its  continued  use,  but  the  writer  has  given  hyoscine  in 
doses  of  gr.  i-ioo  for  seven  years,  and  the  dose  had  only  doubled 
in  that  time.  This  was  a  case  of  paralysis  agitans. 

Even  morphine  and  cocaine  habitues  have  taken  hyoscine  as  a 
hypnotic  for  long  periods  without  increasing  the  dose  above 
gr.  i-ioo. 


248  HYOSCINE  HYDROBROMATE 

Therapeutics. — Hyoscine  does  not  act  well  in  all  cases.  Where 
it  does,  as  a  hypnotic,  it  leaves  nothing  to  be  desired ;  but  in  others, 
doses  sufficient  to  affect  the  cerebrum  are  followed  by  annoying  dry- 
ness  of  the  throat  and  redness  of  the  face  and  neck — in  fact  by 
atropine  symptoms. 

Cushny  thinks  hyoscine  less  dangerous  than  atropine,  as  re- 
covery has  ensued  when  a  dose  of  gr.  1-12  was  taken,  while  7^ 
grains  failed  to  kill  a  small  cat.  But  Shoemaker  says  hyoscine  is 
very  much  more  powerful  than  hyoscyamine,  and  with  this  we 
concur.  The  same  author  states  that  hyoscine  may  be  used  with 
advantage  to  allay  the  convulsions  of  cerebro-spinal  meningitis;  to 
check  spermatorrhea ;  and  to  quiet  great  nervous  excitement  with 
insomnia. 

Hyoscine  has  been  recently  advocated  as  a  hypnotic  in  the 
treatment  of  the  morphine  habit.  The  patient  is  duly  prepared,  the 
morphine  stopped  and  hyoscine  administered  in  doses  of  gr.  1-200, 
rising  if  well  borne  to  1-50,  repeated  as  often  as  necessary  to  keep 
the  patient  in  a  stupefied  state  till  the  withdrawal  period  has  passed. 
The  doses  are  given  every  half-hour  if  necessary ;  in  fact,  whenever 
the  patient  shows  signs  of  becoming  conscious  and  troublesome. 
While  several  good  observers  have  reported  favorably  on  this 
method,  it  is  repugnant  to  the  principles  that  should  govern  the 
treatment  of  these  cases,  and  we  believe  is  a  very  dangerous  method. 

Dr.  J.  A.  Rawls,  of  Iowa,  used  hyoscine  as  a  hypnotic  in  a  case 
of  acute  alcoholic  mania,  sleep  following  the  sixth  dose  of  gr. 

I-IOOO. 

The  writer  has  found  hyoscine  valuable  in  anemic  cases,  and 
for  insomnia  without  fever,  adding  aconitine  for  the  latter;  and  in 
night  terrors,  somnambulism,  nocturnal  convulsions,  etc.,  when  the 
causal  indication  has  been  met,  hyoscine  with  cicutine  hydrobromate 
has  answered  well. 

Acute  senile  decay  in  an  aged  lady,  with  slow  and  irregular 
pulse  and  night  terrors,  screaming  fits  and  suspension  of  assimila- 
tion and  excretion — for  this  Fotheringham  gave  hyoscine  gr.  i-ioo 
by  mouth  in  the  evening,  repeated  in  two  hours  when  necessary, 
and  in  the  morning,  with  an  excellent  recovery  in  two  weeks.  The 
same  writer  reported  the  success  of  this  remedy  in  pneumonic 
meningitis  with  delirium,  mild  and  severe  hysteria,  and  delirium 
with  rheumatic  endocarditis. 

Sexton  reports  extremely  alarming  symptoms  from  doses  of  gr. 
i-ioo  which  he  seeks  to  avoid  by  combining  morphine  with  it. 


HYOSCYAMINE  249 

Hyoscine  and  morphine  have  been  used  as  an  anesthetic  for 
cases  which  cannot  use  the  volatile  anesthetics.  Morphine  gr.  1-8 
to  1-4  with  hyoscine  gr.  i-ioo  is  injected  hypodermically,  repeated 
in  half  or  one  hour  if  necessary,  and  again,  when  usually  even  a 
capital  operation  may  be  performed  painlessly,  or  with  the  aid  of 
the  merest  whiff  of  chloroform.  The  method  has  scarcely  been 
long  enough  before  the  profession  to  say  the  last  word  concerning 
its  merits.  The  writer  has  employed  it  with  success.  Some  cases 
have  been  reported  where  alarming  symptoms  followed,  but  to  those 
who  are  unfamiliar  with  the  action  of  hyoscine,  its  usual  action 
may  be  "alarming;"  and  too  much  weight  is  not  to  be  given  such 
reports.  But  in  general  this  is  preeminently  a  drug  for  the  small 
dose  rapidly  repeated  till  effect. 


HYOSCYAMINE. 

Standard  granules— Amorphous,  gr.  1-250,  gm.  .00025;  crystallized,  gr. 
i-iooo,  gm.  .0000625. 

Hyoscyamine  was  produced  by  Ladenburg  in  a  state  of  purity 
about  1880,  though  it  had  been  recognized  by  Geiger  and  Hesse  in 
1833.  According  to  Merck  there  is  absolutely  no  difference  between 
atropine  and  hyoscyamine  as  to  effects  physiologic  and  therapeutic. 
Cushny  says  that  while  the  resemblance  is  very  close  there  are  dif- 
ferences. Hyoscyamine  is  less  stimulating  to  the  central  nervous 
system,  the  garrulous  delirium  of  atropine  being  replaced  by  the 
symptoms  of  cerebral  depression,  fatigue,  drowsiness  and  eventually 
sleep.  The  slumber  is  more  like  normal  sleep  than  that  produced 
by  morphine ;  the  patient  is  easily  aroused  and  less  confused.  •  It  is 
by  no  means  constant,  and  the  atropine  effects  may  appear  instead. 
After  atropine,  sleep  rarely  follows.  In  fact,  after  studying  Cushny's 
description,  one  suspects  that  he  has  been  experimenting  with  un- 
certain and  mixed  samples  of  these  drugs.  While  some  say  that 
hyoscyamine  acts  more  strongly  on  the  heart,  pupils  and  sweat 
glands  than  atropine,  others  deny  this. 

Hnesemann  and  Hilger  say  that  the  two  differ  in  that  hyos- 
cyamine causes  a  transient  dilatation  of  the  abdominal  vessels,  an 
elevation  of  the  abdominal  temperature  and  a  diminution  of  that 
of  the  rectum. 

Van  Renterghem  divided  three  milligrams  of  Merck's  white 
crystallized  hyoscyamine  into  six  doses,  and  beginning  at  7  p.  m., 
took  five  of  these  at  half-hour  intervals.  Twenty  minutes  after  the 


250  HYOSCYAMINE 

first  dose  he  felt  dryness  of  the  throat;  at  7:40  the  pulse  became 
faster ;  at  8  redness  of  face  and  neck ;  at  8 130  sense  of  cold,  light 
shivering;  tongue  and  whole  mucosa  of  mouth  and  throat  dry,  dif- 
ficult to  speak;  at  9:00,  the  mucous  dryness  was  embarrassing,  im- 
possible to  insalivate  any  food,  deglutition  almost  impossible,  able 
to  swallow  with  the  aid  of  a  little  water,  speech  difficult,  disposition 
to  sleep,  vision  troubled,  gait  uncertain. 

Excellent  sleep  followed,  the  experimentor  rising  twice  to  drink. 
Next  day  the  throat  was  still  somewhat  dry,  but  all  other  phenomena 
had  disappeared. 

Therapeutics. — The  consensus  of  experience  seems  to  be  that 
while  hyoscyamine  closely  resembles  atropine,  the  former  is  milder 
in  action,  less  apt  to  cause  delirium,  or  to  increase  the  pulse-rate,  and 
disposes  to  sleep  as  an  ulterior  effect.  It  has  been  recommended  in 
paralysis  agitans,  senile  and  mercurial  tremors,  neuralgia,  acute 
mania,  chorea,  delirium  tremens,  and  epilepsy;  in  small  doses  it  is 
narcotic  and  calmative ;  for  vesical  tenesmus,  the  delusions  of  per- 
secution, spasmodic  cough,  laryngismus  stridulus,  hiccough,  and 
whooping-cough.  In  all  these  hyoscyamine  should  be  administered 
in  very  small  doses,  repeated  every  five  to  sixty  minutes,  till  the 
first  indication  of  its  action  is  manifested  in  dryness  of  the  mouth 
or  throat,  and  immediately  suspended ;  as  there  will  be  no  benefit 
derived  from  pushing  the  remedy  beyond  this  point.  It  is  best  given 
in  hot  solution  to  secure  the  quickest  effect.  The  dose  of  the 
amorphous  alkaloid  for  such  cumulative  dosage  is  gr.  i-iooo;  and 
many  persons  will  be  found  who  cannot  take  the  granule  gr.  1-250 
without  unpleasant  effects. 

In  alienist  practice  hyoscyamine  has  been  found  useful  in  ag- 
gressive mania,  chronic  forms  with  hallucinations,  subacute  and  re- 
current mania,  the  irritative  stages  of  general  paralysis,  and  in 
epilepsy.  Maniacs  who  tear  their  clothes  quit  this  quickly  and  for 
a  long  time  after  some  doses  of  hyoscyamine.  Some  have  pre- 
scribed it  with  success  in  mania  with  periodic  irritation,  and  in  cir- 
cular mania.  Seguin  preferred  it  to  chloral  in  delirium.  Sepilli 
and  Riva  found  the  access  and  gravity  of  epileptic  seizures  diminish 
under  its  influence.  Kretsch  advised  against  its  use  when  hallucina- 
tions of  vision  were  present.  Lawson  and  Doerrenberg  advised 
hyoscyamine  for  retention  of  urine  and  coprostasis  of  the  insane, 
but  Von  Schroff  preferred  atropine  here. 

As  an  anodyne  hyoscyamine  has  been  employed  largely.  Oul- 
mont  injected  it  for  neuralgias,  tetanus,  trembling  paralysis,  tremors 


HYOSCYAMINE  251 

of  old  age  and  of  mercurialism,  with  complete  success.  Millican 
gave  it  for  hepatic  colic,  perityphlitis  and  asthma;  Von  Schroff  as 
a  calmative  for  coughs. 

In  America  hyoscyamine  has  assumed  an  important  role  as  a 
combined  analgesic  and  antispasmodic.  In  the  very  numerous 
cases  in  which  pain  of  a  spasmodic  form  is  to  be  conquered,  this  is 
the  first  of  remedies.  In  the  atrocious  pangs  of  gall-stones  and 
urinary  calculi,  in  all  forms  of  colic,  hyoscyamine  has  wholly  re- 
placed the  less  efficient  and  more  dangerous  morphine.  Here  full 
doses  are  needed,  and  glonoin  is  added  to  open  the  blood-vessels 
and  secure  prompt  effect,  with  strychnine  arsenate  to  steady  the  af- 
fected nerves,  and  this  triad  forms  probably  the  most  generally 
applicable  anodyne-antispasmodic  in  our  possession. 

Abbott  has  placed  hyoscyamine  before  the  profession  as  a 
remedy  for  various  forms  of  intestinal  obstruction,  such  as  impac- 
tion  of  feces,  and  strangulated  hernia.  Before  resorting  to  pro- 
longed and  painful  efforts  at  reduction,  give  a  full  dose  of  this 
agent,  enough  to  produce  redness  of  the  skin,  and  in  a  few  hours  it 
will  often  be  found  that  spontaneous  reduction  has  followed  the  re- 
laxation of  the  spasm  that  held  the  bowel  imprisoned.  The  treat- 
ment of  impaction,  and  of  all  but  the  suppurative  forms  of  ap- 
pendicitis, of  perityphlitis,  etc.,  by  hyoscyamine  has  been  advocated 
by  Dr.  Zophar  C.  Case,  who  has  published  series  of  cases  that  would 
convince  anyone  but  a  bigoted  adherent  of  the  "no  treatment  but 
the  knife"  creed.  The  truth  seems  to  be  unknown  to  these  gentle- 
men that  in  many  cases  the  obstruction  is  spasmodic,  and  hence 
amenable  to  this  potent  remedy.  These  uses  of  hyoscyamine  have 
rendered  it  one  of  the  most  important  agents  in  our  armamentarium. 
Between  it  and  atropine  the  choice  is  generally  a  matter  for  indi- 
vidual preference.  Possibly  the  anodyne  effect  of  the  latter  is  less 
pronounced. 

Children  take  larger  doses  of  hyoscyamine  than  adults,  pro- 
portionally. Van  Renterghem  gives  newborn  infants  one-eighth  of 
a  milligram  at  a  dose,  or  about  gr.  1-500.  This  seems  a  huge  dose, 
and  we  suspect  that  this  author  has  a  weaker  hyoscyamine  than  that 
used  in  American  practice.  Certainly  his  doses  for  adults,  gr.  1-134 
every  quarter-hour,  cannot  be  employed  here.  But  Prideaux  gave 
six  milligrams — gr.  i-n — in  acute  mania;  and  Lawson  8  milli- 
grams— gr.  1-8— in  general  paralysis  of  the  insane.  Seguin  gave 
50  milligrams  at  a  dose  in  chronic  mania— equal  to  gr.  5-6.  The 
purity  of  the  drug  employed  may  well  be  questioned. 


252  IODOFORM 

Poisoning  with  hyoscyamine  is  to  be  treated  exactly  as  that 
from  atropine. 

Many  other  applications  of  hyoscyamine  have  been  reported  by 
American  advocates  of  alkalometry.  Thus  Fretz  met  a  case  of 
delirium  with  retention  of  urine  in  typhoid  fever.  The  patient 
would  have  required  an  anesthetic  to  permit  catheterization.  Hyos- 
cyamine was  given  every  fifteen  minutes,  and  five  doses  relieved. 

W.  L.  Day  reported  a  case  of  gastric  cramps  where  morphine 
had  failed  to  give  relief.  Three  doses  of  hyoscyamine  and  strych- 
nine arsenate  removed  the  difficulty. 

George  Mott  gave  hyoscyamine  with  codeine  for  thoracic 
neuralgia  with  bronchitis,  relieving  the  pains  and  causing  curious 
hallucinations  of  sight  and  hearing.  H.  I.  Terpening  reported  the 
case  of  an  aged  paralytic  with  attacks  of  dyspnea  and  tremor, 
quickly  relieved  and  cured  in  three  weeks  by  hyoscyamine. 

\ 
IODOFOBM. 

Standard  granules — Gr.  1-67,  gm.  .001 ;  gr.  1-6,  gm.  .01. 

lodoform,  CHI3,  may  be  prepared  by  heating  sodium  carbonate, 
alcohol,  water  and  iodine  together.  It  occurs  in  yellow,  shiny 
scales,  soluble  in  alcohol  and  in  ether  but  almost  insoluble  in  water. 
It  contains  96.68  per  cent  of  iodine,  combined  with  the  carbon 
firmly  enough  to  resist  everything  short  of  decomposition  of  the 
molecule,  yet  broken  up  by  solar  light.  In  the  animal  body  iodo- 
form  is  decomposed,  and  eliminated  by  the  kidneys,  skin  and  lungs, 
in  the  form  of  iodine  salts  and  a  little  undecomposed. 

Taken  internally  or  applied  to  open  surfaces,  too  long  or  in  too 
large  doses,  symptoms  of  intoxication  appear.-  These  begin  with  a 
sudden  acceleration  of  the  pulse  and  slowing  of  respiration;  the 
temperature  rises  at  first,  then  sinks  later;  nausea,  vomiting, 
anorexia,  diarrhea,  follow.  These  disappear  if  the  remedy  is 
suspended.  If  not,  grave  disturbances  occur,  excitement,  insomnia, 
coma,  hallucinations  of  persecution,  mania,  convulsions,  and  on  re- 
covery the  memory  may  be  weak.  There  may  be  continual  anorexia 
with  albuminuria  and  tube  casts.  A  harmless  exanthem  and  purpura 
may  appear.  The  symptoms  may  persist  for  weeks,  and  end  in 
death  from  heart  paralysis,  or  a  grave  meningo-cephalitis. 

Advanced  age  predisposes  to  iodoform  intoxication,  and  the 
remedy  must  be  employed,  if  at  all,  with  great  caution  in  such 
persons. 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


IODOFORM  863 

lodoform  does  not  destroy  the  vitality  of  the  tubercle  bacillus, 
nor  does  it  influence  bacteria  in  general.  The  theory  as  to  its  un- 
questioned beneficial  action  is  that  it  strengthens  the  affected  cells, 
in  resisting  the  parasitic  invasion — a  theory  unsatisfactory  to  those 
who  have  noted  most  closely  the  effects  of  iodoform  in  tuberculosis. 
No  known  decomposition  product  of  iodoform  exerts  as  beneficial 
an  action. 

Therapeutics. — Externally  iodoform  is  used  as  a  healing,  anodyne 
and  antiseptic  dressing.  For  chancroids  it  has  probably  no 
equal.  Old  ulcers  often  refuse  to  heal  because  the  sensory  nerve 
terminals  are  exposed ;  and  prompt  and  decided  benefit  results  from 
the  application  of  iodoform  ointment.  Irritable  ulcers,  such  as  fre- 
quently appear  in  the  mouth,  are  quickly  relieved  and  heal  promptly 
when  iodoform  is  applied — best  in  scales,  not  powdered.  The  pains 
of  ulcerated  cancers  are  relieved  by  it. 

Internally  iodoform  has  been  employed  extensively  in  the  treat- 
ment of  pulmonary  tuberculosis.  It  soothes  the  cough  and  causes 
improvement  in  the  affected  region,  but  just  how  is  unknown.  It 
was  supposed  to  combat  the  bacilli  directly ;  then  that  it  disinfected 
the  pulmonary  tract,  or  interfered  with  the  development  of  some 
of  the  bacteria  concerned  in  the  work  of  destruction;  but  as 
with  the  modus  operandi  of  internal  antiseptics  in  general,  the  more 
they  are  studied  the  more  difficult  the  problem  becomes.  The  truth 
is,  our  knowledge  of  the  physiologic  functions  is  too  superficial  to 
base  upon  it  much  of  value  as  to  the  true  action  of  remedies.  Too 
often  we  must  content  ourselves  with  the  knowledge  that  certain 
beneficial  effects  follow  the  use  of  a  remedy,  without  being  able  to 
explain  how  the  results  are  produced. 

But  when  given  to  patients  with  pulmonary  consumption  of  all 
grades  iodoform  brings  about  a  general  improvement,  the  cough 
moderating,  the  sputa  healthier,  and  the  disease  processes  apparently 
ameliorated.  J.  Solis-Cohen  said  that  from  iodoform  he  had  ob- 
tained more  benefit  than  from  any  other  in  treating  this  malady. 
Chauvin  and  Jorissenne  praised  it  as  a  remedy  for  hemoptysis. 

lodoform  has  been  recommended  as  a  remedy  for  neuralgia, 
catarrhal  jaundice,  the  early  stages  of  hepatic  cirrhosis,  syphilis,  to 
check  gastric  fermentation,  for  dysentery,  diabetes,  tenia  and 
ascarides.  In  fact,  iodoform  has  been  urged  as  a  useful  form  for 
the  introduction  of  iodine  into  the  system ;  but  except  in  tuberculosis 
this  can  better  be  accomplished  by  the  use  of  iodized  calcium  or  the 
iodides  of  mercury,  iron,  arsenic,  etc. 


254  IRIDIN 

Shoemaker  suggests  the  following  test  for  approaching  iodoform 
intoxication:  Mix  a  few  drops  of  urine  with  calomel,  by  a  glass 
rod,  on  a  white  plate;  if  iodine  is  being  eliminated  in  dangerous 
quantities  there  is  produced  a  well-marked  yellow  discoloration. 

No  application  appears  to  have  been  made  as  yet  of  the  power 
of  iodoform  to  increase  the  thyroid  secretion.  The  same  is  true 
of  Binz'  discovery  that  iodoform  hinders  the  diapedesis  of  leu- 
cocytes. 

Iodoform  has  been  advocated  as  an  intestinal  disinfectant,  but 
there  are  other  and  more  reliable  agents,  less  dangerous. 

F.  Warren  Lanoix  found  that  the  headache  affecting  miners 
from  the  fumes  of  blasting  powder  was  quickly  relieved  by  inhal- 
ing the  iodoform  from  a  bit  of  gauze. 

Iodoform  should  be  given  by  the  intensive  method.  The  dose 
should  not  exceed  gr.  1-6,  and  for  very  susceptible  patients  the 
granule  of  gr.  1-67  should  be  used.  One  of  either  may  be  given 
every  hour  or  even  oftener,  till  the  patient  begins  to  taste  or  smell 
the  drug,  which  is  an  evidence  of  saturation,  when  it  should  be  dis- 
continued or  given  in  smaller  doses  or  less  frequently.  Tuberculous 
patients  evince  a  remarkable  tolerance  for  iodoform,  and  the  writer 
has  given  fifteen  grains  a  day  to  these  patients;  but  it  is  better  to 
use  europhen,  which  is  less  apt  to  part  with  its  iodine  and  cause 
toxemia.  Some  persons  evince  an  idiosyncrasy  against  all  these 
iodic  compounds,  and  this  may  even  be  hereditary.  The  writer 
once  applied  a  very  small  dusting  of  europhen  to  an  anal  fissure 
and  next  day  an  intertrigo  had  developed  that  took  off  the  epi- 
thelium from  the  umbilicus  to  the  knees.  The  daughter  of  this  pa- 
tient was  similarly  affected  by  the  same  agent ;  and  both  proved  re- 
fractory to  all  forms  of  iodine,  locally  applied. 

• 

IEIDIN. 

Standard  granules — Gr.  1-67,  gm.  .001 ;  gr.  1-12,  gm.  .005. 

Iridin  is  a  resin  derived  from  the  Iris  versicolor,  or  blue  flag. 

Felter  and  Lloyd  attribute  the  virtues  of  iris  to  the  oil,  which 
forms  a  constituent  of  iridin. 

The  same  authors  say  that  iris  acts  upon  the  gastrointestinal 
canal,  the  glandular  and  nervous  systems;  powerfully  exciting  the 
biliary,  salivary  and  pancreatic  secretions.  It  causes  violent  acid 
vomiting,  frequent  hydragog  catharsis,  intestinal  burning  and  severe 
colic.  After  fatal  doses,  marked  gastrointestinal  congestion  is 


IRIDIN  266 

found.  It  has  produced  neuralgia  of  the  face,  head  and  extremities. 
It  causes  salivation  but  without  injuring  the  gums  or  the  teeth.  It 
is  alterative  and  cholagog,  one  of  the  best  agents  to  influence  waste 
and  repair,  exerting  a  powerful  catalytic  action  upon  the  lymph 
glands,  the  ductless  glands,  the  liver,  pancreas  and  kidneys.  It  does 
excellent  service  in  cachexias,  bad  blood,  scrofula  and  mercurialism ; 
and  in  secondary  syphilis  with  cerebral  disturbance  and  coppery 
skin  is  one  of  the  best  remedies.  For  biliousness  it  is  prompt  and 
efficient;  for  bilious  headache  with  nausea  and  bitter  vomiting,  or 
sick  headache  from  indigestion  it  is  unsurpassed.  Other  conditions 
for  which  Felter  and  Lloyd  recommend  this  agent  are:  Chronic 
hepatitis  and  other  hepatic  affections  with  constipation  and  sharp, 
cutting  pains  increased  on  motion;  duodenal  catarrh  with  jaundice 
and  clayey  stools;  constipation  from  torpor;  in  minute  doses  for 
gastric  irritation  in  cholera  infantum  and  morbus ;  diarrhea  and 
dysentery  with  large,  slimy  evacuations;  gastralgia;  aphthae;  reflex 
muscular  pains  from  gastrointestinal  or  pancreatic  disorders,  es- 
pecially when  the  muscular  coats  of  the  viscera  are  affected ;  pectoral 
and  subscapular  pains ;  soft,  glandular  enlargements ;  goiter  or  en- 
larged thyroid — one  of  the  few  reliable  drugs  here — whether  con- 
stant or  menstrual;  ovarian  and  uterine  disturbances  with  goiter 
(use  internally  and  locally)  ;  exophthalmic  goiter  in  early  stages ;  im- 
proves Addison's  disease;  chronic  pancreatic  diseases  with  sodden, 
lead-colored  tongue,  chronic  splenic  disease  with  white  skin — 
leucocythemia ;  chronic  renal  diseases,  ascites,  anasarca,  hydro- 
thorax,  hydropericardium  (in  dropsies  given  in  cathartic  doses,  with 
ginger,  piperine  or  camphor)  ;  uterine  hypertrophy,  enlarged  ovaries, 
ulcerated  os  and  cervix  uteri,  uterine  leucorrhea  and  dysmenorrhea, 
especially  with  impaired  health,  mental  depression  and  pigmented 
skin;  chronic  and  syphilitic  rheumatism,  gonorrhea,  spermatorrhea 
and  prostatorrhea  and  nocturnal  emissions  from  masturbation,  with 
debility,  mental  uneasiness  and  centric  nervous  irritation ;  syphilitic 
iritis  (Scudder)  ;  malarial  jaundice,  intermittent  and  bilious  remit- 
tent fevers,  with  euonymin ;  for  vomiting  of  pregnancy  iridin  3  gr. 
at  bedtime  with  a  saline  in  morning ;  comedones  and  other  skin  af- 
fections of  youth,  chronic,  with  genital  disorders,  rough  greasy 
skins;  full  thyroids  in  women;  syphilides,  eczema  rubrum  of  chil- 
dren and  capitis  of  adults,  zoster  and  herpes  preputialis,  with  rhus ; 
rupia  and  impetigo  with  sulphur  or  arsenic,  lepra ;  pustules  on  head 
in  children ;  in  all  cases  associating  other  indicated  remedies. 


256  IRON 

Specific  Indications. — Thyroid  fullness,  enlarged  spleen,  chronic 
hepatic  disease,  with  sharp,  cutting  pain  worse  on  motion;  nausea 
and  vomiting  of  sour  liquids  or  regurgitation  of  food,  after  rich 
pastry  or  fats ;  watery,  burning  stools ;  enlarged  lymphatics,  soft  and 
yielding;  rough,  greasy  skin  with  sebaceous  disease;  menstrual 
wrongs  with  large  thyroid;  unilateral  facial  neuralgia;  wasting 
muscles  and  other  atrophies,  and  bad  blood. 

Ellingwood  says  iris  promotes  waste  and  elimination  of  effete 
material  from  the  blood.  It  will  prove  serviceable  when  the  stools 
are  clayey,  urine  scanty,  skin  inactive  and  jaundiced;  digestive  ir- 
ritations with  altered  secretions;  neuralgia  over  right  eye;  acid 
nausea  with  gastralgia,  after  rich  food;  burning  diarrhea;  cholera 
morbus  with  violent  umbilical  pain,  serous  stools  and  great  depres- 
sion. Henson  says  only  the  green  root  preparations  are  active.  These 
rival  phytolacca  in  their  beneficial  effect  on  diphtheria  and  tonsillitis. 

He  pronounces  it  a  mild  hepatic  stimulant,  with  an  especial 
curative  effect  on  the  stomach  resembling  that  of  sodium  sulphite. 
It  acts  on  the  pancreas,  a  power  shared  only  by  iodine,  mercury,  and 
perhaps  mandrake  and  cinchona.  The  key  to  the  use  of  iris  is  when 
the  spleen  and  pancreas  are  affected  as  well  as  the  liver,  with  sour 
stomach,  vomiting  acid  or  yeasty  half-digested  food  an  hour  after 
meals.  If  the  liver  is  also  torpid  add  podophyllin ;  for  constipation, 
aloes  for  men,  juglandin  for  women;  or  cascara.  If  the  whole 
alimentary  canal  needs  toning,  give  hydrastine,  which  will  relieve 
the  diarrhea. 

Van  Renterghem  took  Merck's  iridin  up  to  doses  of  a  gram, 
without  much  effect.  But  this  is  one  of  the  remedies  that  requires 
bile  to  develop  its  activity;  and  the  small  granules  made  with  in- 
spissated oxgall  are  active.  Ellingwood  gives  the  dose  of  the  oleo- 
resin  as  one  to  five  grains.  The  eclectics  employ  specific  iris  in  doses 
from  a  fraction  of  a  drop  up  to  five  drops.  They  do  not  employ  iris 
as  a  cathartic.  For  chronic  cases  it  seems  best  to  give  small  doses, 
gr.  1-67  to  1-6  before  meals  and  at  bedtime,  increasing  as  may  be 
indicated,  and  watching  the  stools  for  the  effect,  rather  than  the 
large  irritative  doses. 

IRON. 

Standard  granules — Iron  arsenate  gr.  1-67 — 1-6,  gm.  .001 — .01 ;  iron  iodide 
gr.  1-12,  gm.  .005 ;  iron  phosphate  gr.  1-67 — 1-6,  gm.  .001 — .01 ;  iron  valerianate 
gr.  1-6,  gm.  .01. 

Cushny  says  that  iron  is  probably  essential  to  all  forms  of  proto- 
plasmic life.  Small  doses  of  persalts  of  iron  have  an  astringent 


IRON  257 

taste ;  in  larger  doses  they  cause  pain  and  nausea,  vomiting  and  even 
purging.  The  gastrointestinal  disorder  may  be  so  severe  as  to 
occasion  collapse.  The  prolonged  use  of  iron  causes  dyspepsia, 
constipation  and  colic,  if  the  iron  collects  in  the  bowel  in  the  form 
of  sulphide.  Blackening  of  the  teeth  may  be  caused  by  the  acid 
present,  by  the  formation  of  iron  sulphide,  or  by  the  union  of  tannic 
acid  from  the  food  with  the  iron.  Iron  increases  the  secretion  of 
hydrochloric  acid  (Buzdygan).  The  salts  of  iron  with  organic 
acids  hinder  digestion  more  than  the  salts  with  inorganic  acids, 
ferric  salts  more  than  ferrous,  and  the  insoluble  salts  the  least  of 
all.  The  digestion  of  starch  is  scarcely  affected  by  iron.  Given  by 
the  mouth  iron  induces  leucocytosis  (Pohl),  and  does  not  affect  the 
renal  excretion  of  double  sulphates,  hence  has  no  intestinal  anti- 
septic action  (JV^oerner). 

When  the  double  salts  of  iron  are  injected  into  the  blood,  they 
occasion  toxic  symptoms,  disturbed  respiration,  gastrointestinal 
disturbances,  casts  and  albumin  in  the  urine,  the  postmortem  show- 
ing the  gastrointestinal  mucosa  congested  with  extravasations,  the 
kidneys  also  congested.  In  acute  poisoning  the  alkalinity  of  the 
blood  is  reduced  by  the  lactic  acid  formed.  The  effect  on  the 
central  nervous  system  is  depressing,  to  paralysis,  but  this  may  be 
due  to  the  gastric  effects.  Very  large  doses  dilate  the  blood  vessels. 
The  astringency  is  due  to  the  precipitation  of  proteids. 

When  iron  is  injected  into  the  blood  about  2  to  5  per  cent  of  it 
reappears  in  the  urine,  the  rest  being  stored  up  in  the  liver  and 
spleen,  and  possibly  in  the  marrow,  whence  it  is  slowly  taken  by 
the  various  tissues,  and  excreted  by  the  mucosa  of  the  large  bowel. 
Iron  is  absorbed  by  the  duodenal  mucosa,  carried  along  the  lym- 
phatics to  the  blood,  stored  in  the  spleen,  taken  through  the  portal 
blood  to  the  liver,  stored  there  for  a  longer  time,  and  slowly  dis- 
tributed through  the  blood,  finding  its  way  out  through  the  large 
bowel.  Nothing  is  known  with  certainty  as  to  the  form  in  which 
iron  is  absorbed.  It  passes  through  the  thoracic  duct  to  reach  the 
blood.  While  there  is  usually  plenty  of  iron  in  the  food,  there  is 
decided  benefit  from  the  administration  of  iron  as  medicine.  This 
is  explained  on  the  theory  that  the  food  iron  is  so  enveloped  in  col- 
loids that  its  absorption  is  hindered. 

Therapeutics. — The  presence  of  iron  in  the  blood  and  every  tis- 
sue, sufficiently  justifies  its  use  as  a  nutrient  tonic.  When  given 
in  proper  remedial  doses  iron  increases  the  appetite,  stimulates  the 
digestion,  tends  to  check  diarrhea  if  present  and  to  constipate  if 


258  IRON. 

not.  The  blood  improves  in  quality,  the  color  freshens,  the  eyes 
brighten,  and  the  pallor  of  anemia  gives  place  to  the  rosy  hue  of 
health.  When  the  smallest  doses  of  iron  are  given,  most  of  it  ap- 
pears in  the  blackened  stools.  Very  little  is  absorbed,  and  this  has 
led  some  to  recommend  doses  too  small  to  cause  this  blackening. 
But  experience  has  shown  that  a  certain  percentage  of  the  daily 
dose  is  absorbed ;  and  that  if  the  dose  is  increased  to  the  full  toler- 
ance, the  same  percentage  of  this  larger  dose  will  still  be  absorbed. 
Hence  the  rule  promulgated  by  Niemeyer,  in  cases  of  chlorosis,  to 
give  all  the  iron  the  stomach  will  bear;  and  the  results  of  this 
medication  he  pronounced  the  most  brilliantly  successsful  in  the 
practice  of  medicine.  But  when  iron  is  thus  given  there  is  a 
tendency  for  large  quantities  to  accumulate  in  the  bowel  in  the  form 
of  an  insoluble  sulphide,  and  this  may  cause  obstruction  or  ulcera- 
tion.  This  may  be  prevented  by  administering  every  two  or  three 
days  a  dose  of  some  saline  cathartic,  sufficient  to  clear  the  bowels 
of  the  ferruginous  accumulation. 

It  has  been  found  that  when  Nuclein  solution  is  given  at  the 
same  time  as  iron,  the  proportion  of  the  latter  that  is  held  in  the 
body  is  increased. 

Iron  is  useful  in  all  cases  of  anemia,  whether  essential  or  due  to 
organic  disease,  with  exceptions  to  be  hereinafter  noted.  It  thus 
relieves  many  affections  that  depend  upon  anemia  for  their  presence, 
such  as  amenorrhea,  neuralgia  and  various  neuroses,  dyspepsia, 
etc.  When  there  is  a  cause  of  the  anemia  evident  it  is  of  course 
to  be  treated  as  well;  and  neglect  of  this  simple  rule  is  the  reason 
many  persons  improve  while  taking  iron  and  drop  back  when  it  is 
discontinued.  Thus,  if  the  anemia  be  due  to  constipation  and  fecal 
absorption,  it  is  folly  to  give  iron  without  at  the  same  time  regulat- 
ing the  bowels. 

Iron  is  thus  given  for  anemic  dropsy,  in  convalescence  from 
fevers,  the  cachexias  of  malaria,  syphilis,  mercurialism,  chronic  dis- 
eases. In  asthenic  erysipelas  the  tincture  of  the  chloride  of  iron  has 
done  the  greatest  good  of  any  remedy  the  writer  has  ever  employed, 
when  given  in  full  doses — a  dram  every  four  hours — but  in  the 
sthenic  form  it  is  worse  than  useless.  The  perchloride  is  the  most 
effective  of  the  local  astringents. 

Iron  in  small  and  frequent  doses  is  efficient  for  passive  hemor- 
rhages, and  when  postpartum  bleeding  has  been  reduced  to  a  dribble 
which  yet  resists  ergotin.  But  diathetic  bleeding  is  increased  by 
iron,  and  in  some  cases  postpartum  hemorrhage  will  continue  as 


THERAPEUTIC   NOTES 


THERAPEUTIC    NOTES 


IRON  269 

long-  as  iron  is  given.  When  hemorrhage  continues  from  anemia, 
it  is  wise  to  give  the  salts  of  lime  to  restore  strength  to  the  blood- 
vessels and  then  the  iron  will  accomplish  its  duty  far  better. 

In  desquamative  nephritis  iron  has  been  largely  given,  the  use 
of  Basham's  mixture  being  a  routine  with  many  practicians.  The 
writer  has  never  known  of  benefit  from  it ;  though  the  anemia  re- 
sulting from  this  malady  may  be  benefited  by  iron  provided  elimina- 
tion is  perfectly  unobstructed.  Otherwise  iron  is  apt  to  do  harm. 

As  iron  increases  the  excretion  of  urea  and  the  frequency  of 
micturition,  it  deserves  to  rank  among  the  diuretics ;  but  this  power 
has  only  been  utilized  in  treating  the  dropsies  of  anemia. 

Smart  says  the  sulphate  is  the  best  chalybeate  to  increase  the 
number  of  the  red  blood  corpuscles  and  their  hemoglobin,  the  car- 
bonate ranking  next  and  the  chloride  third.  But  much  depends  on 
the  mode  of  administration. 

Shoemaker  mentions  as  adapted  to  the  use  of  iron,  subacute  and 
chronic  eczema  with  anemia;  pseudoleukemia,  acute  rheumatism  in 
anemics,  to  alternate  with  mercury  in  debilitated  syphilitics,  chorea 
(iron  bromide),  gonorrhea,  leucorrhea,  tuberculosis,  anemic  hysteria 
with  amenorrhea,  for  neurasthenia  with  palpitation  of  the  heart, 
anemic  puerperal  mania  and  that  of  lactation;  rachitis;  profuse 
mucous  discharges,  dilatation  of  the  stomach,  thread  worms,  em- 
physema and  phthisis;  fatty  and  dilated  heart;  nocturnal  incon- 
tinence of  urine ;  spermatorrhea  with  relaxation  and  anemia ;  vaso- 
motor  disturbances  of  the  menopause. 

The  contraindications  for  iron  are:  Plethora,  the  apoplectic 
tendency,  hypertrophy  of  the  heart ;  acute  fever,  of  the  sthenic  type 
especially;  active  hemorrhage,  and  the  hemorrhagic  diathesis; 
florid  phthisis,  where  the  use  of  iron  was  shown  by  Trousseau  to 
induce  hemorrhages  from  the  bronchi;  active  gastric  catarrh,  and 
acute  affections  of  the  stomach  or  intestines,  which  are  made  more 
active  by  iron. 

When  persons  long  anemic  have  their  blood  improved  by  iron, 
they  are  apt  to  suffer  from  headache,  the  brain  having  been  ac- 
customed to  the  thin  blood.  This  may  be  prevented  by  giving  iron 
bromide,  or  by  a  little  hydrobromic  acid.  Usually  all  that  is  needed 
is  to  keep  the  bowels  free  and  aseptic. 

When  the  object  is  to  improve  the  blood  as  quickly  as  possible, 
it  is  best  to  keep  some  iron  ready  for  the  absorbents  constantly,  by 
giving  quite  small  doses  very  frequently.  Of  iron  phosphate  gr. 
1-6  may  be  given  every  half-hour  during  the  day,  and  this  dose  may 


260  IRON 

be  increased  to  a  grain  if  well  borne.  Much  more  will  be  tolerated 
and  absorbed  in  this  way  than  by  the  old  routine  of  three  doses 
a  day. 

In  the  long  list  of  chalybeates  there  is  room  for  endless  variations 
as  to  combinations  with  other  salts,  and  individual  tastes,  conditions 
and  idiosyncrasies.  Numberless  attempts  have  been  made  to  es- 
tablish the  superiority  of  some  one  or  other  salt  of  iron,  on  the  score 
of  assimilability,  etc.,  but  investigation  has  invariably  disproved 
these  claims,  and  shown  that  all  iron  salts  and  preparations  are  use- 
ful in  the  treatment  of  anemia.  Even  iron  filings  have  proved  bene- 
ficial; and  the  scales  scattered  from  the  smith's  anvil.  The  best 
preparation  is  that  which  best  agrees  with  the  taste  of  the  patient 
and  disorders  his  digestion  least,  and  hence  can  be  given  in  the 
largest  doses. 

All  the  tonics  are  synergistic  to  iron,  as  well  as  the  whole  tonic 
regimen  of  cold  or  salt  baths,  high  feeding,  open  air,  mountain  or 
sea-shore,  exercise,  etc. 

IRON     ARSENATE. 

For  the  uses  to  which  iron  is  put  as  a  reconstituent  tonic,  the 
arsenate  is  undoubtedly  the  best  of  the  chalybeates.  While  iron  is 
an  antidote  for  arsenic,  acting  by  rendering  the  latter  insoluble,  this 
insolubility  is  not  absolute  but  relative,  and  prompt  evacuation  of 
the  stomach  must  follow  the  use  of  the  antidote. 

Burggraeve  pronounced  iron  arsenate  the  reconstituent  of  the 
blood,  par  excellence.  "The  blood  is  a  milieu  from  which  all  the 
tissues  draw  the  elements  for  their  reconstitution.  In  cancer, 
tubercle,  scrofula,  it  prevents  the  development  of  morbific  germs 
while  favoring  the  transformation  of  white  cells  into  red.  Look- 
ing on  pathologic  elements  as  physiologic  elements  diverted  from 
their  true  place,  we  may  hope  to  return  them  by  amending  the 
nutritive  processes.  This  is  what  iron  arsenate  does.  In  squamous 
skin  diseases,  lichens,  psoriasis  and  lupus,  it  is  necessary  to  modify 
by  a  powerful  nutrition,  a  fertilized  soil,  the  renovation  of  the 
epidermic  cellules.  Here  it  is  still  the  blood  which  should  be  im- 
proved. And  who  can  say  that  it  is  not  the  elementary  white 
globules  of  this  liquid  that  furnish  the  innumerable  cellules  con- 
stantly in  the  way  of  formation  and  transformation?  There  is  al- 
ways the  formative  nisus,  vitality ;  but  if  the  material  does  not 
possess  the  spontaneity  of  evolution,  the  life  cannot  abstract  itself 
from  the  matter." 


JALAPIN  261 

For  anemia  with  weak  heart  and  oedema  he  associated  iron 
arsenate  with  digitalin,  to  rapidly  reestablish  the  normal  respiratory 
and  circulatory  rhythm.  He  also  employed  this  agent  for  the 
chloroanemias  due  to  delay  of  establishing  menstruation,  in  the 
purulent  cachexia,  etc. 

Hare  recommends  iron  arsenate  in  anemics  with  dry,  scaly  skin 
diseases ;  and  in  the  anemia  of  chronic  diarrhea. 

The  dose  is  gr.  1-67  to  1-6  before  each  meal,  or  the  smaller  dose 
every  half -hour  while  awake.  It  is  well  tolerated. 

IRON  IODIDE. 

Iron  iodide  is  remarkable  from  the  fact  that  both  the  elements 
contained  in  it  exert  their  effects  at  the  same  time,  though  these  are 
to  some  extent  antagonistic.  It  is  especially  suited  to  cases  of 
scrofula,  where  there  is  need  for  stimulating  the  destruction  and 
removal  of  morbid  material  and  rebuilding  healthier  tissue  at  the 
same  time.  The  iodine  in  this  combination  is  very  active,  and  care 
must  be  taken  that  overdosing  does  not  occur.  The  first  intimation 
of  irritation  of  the  eyes  or  nose,  coryza,  sneezing,  should  be  the 
signal  for  lessening  the  doses  or  suspending  the  remedy.  It  is  best 
given  to  adults  in  doses  of  gr.  1-12  every  two  hours. 

In  anemic  syphilitics  this  is  also  a  useful  remedy,  and  may  be 
given  with  the  iodides  of  mercury,  arsenic  and  lime.  It  has  been 
used  to  some  extent  also  in  non-pulmonary  tuberculosis,  and  in 
amenorrhea  with  lymphatic  enlargements. 

IRON  PHOSPHATE. 

Iron  phosphate  is  well  suited  to  any  of  the  uses  of  iron  for  which 
the  arsenate  is  undesirable.  Whether  the  phosphoric  acid  com- 
bined is  useful  in  any  given  case  or  not,  it  is  at  least  harmless. 

IRON  VALERIANATE. 

This  preparation  unites  with  the  properties  of  iron  those  of  an 
antispasmodic  and  nervine.  It  possesses  the  powers  of  valerian  in 
sustaining  the  nerves  and  comforting  the  afflicted  which  render 
that  remedy  so  valued. 

JALAPIN. 

Standard  granule— Gr.  1-67,  gm.  .001. 

Jalapin  is  a  resin  from  Ipomoea  Jalapa.  This  resin  contains  two 
glucosides,  convolvulin  and  jalapin,  the  latter  in  small  quantity.  It 
is  a  drastic  hydragog  purgative  in  large  doses,  requiring  bile  to 
develop  its  activity.  Full  doses  produce  stools  in  two  hours,  with 


262  JUGLANDIN 

much  pain  and  griping.  Toxic  doses  cause  acute  enteritis,  bloody 
stools,  with  a  less  degree  of  gastritis,  as  evidenced  by  nausea  and 
vomiting.  But  moderate  doses  are  less  apt  to  cause  griping  than  the 
aloes  group.  Jalap  is  a  local  irritant  to  the  skin  and  mucosa. 

Jalapin  increases  intestinal  peristalsis  and  is  well  suited  to  cases 
where  hard  scybala  form.  As  a  purgative  to  clear  the  bowel  at  the 
beginning  of  treatment  of  fevers  jalapin  is  suitable;  also  as  a  deriva- 
tive in  cerebral  congestions  and  similar  states  of  the  spinal  cord.  As 
to  dropsies  it  is  now  well  comprehended  that  the  weakening  from 
hydragogs  more  than  counterbalances  the  benefit  derived  from  the 
excretion  of  fluid.  There  are  better  and  safer  ways  of  accomplish- 
ing this  object. 

Jalapin  like  all  purgatives  is  contraindicated  in  acute  intestinal 
irritations  and  inflammations,  menstruation  and  pregnancy,  collapse, 
asthenia  and  anemia;  and  in  cystitis  those  which  act  on  the  lower 
bowel  should  be  avoided.  Dissolved  in  glycerin  from  one  to  three 
drams,  jalapin  acts  effectually  when  injected  into  the  rectum. 

Shoemaker  recommends  jalap  in  congestion  of  the  lungs  with 
distended  right  heart,  lividity,  short  breath  and  cardiac  asthma. 

Felter  and  Lloyd  recommend  jalap  in  inflammations  of  the 
biliary  apparatus;  costiveness,  hemorrhoids;  taken  before  meals  as 
a  remedy  for  excessive  appetite,  to  hasten  expulsion  of  worms. 

Specific  Indications. — Costiveness;  pain  and  griping  in  lower 
bowel ;  colic  with  stercoraceous  vomit ;  general  gastrointestinal 
torpor. 

As  a  cathartic  jalapin  is  only  employed  in  combination  with  other 
drugs  of  this  class.  Given  in  the  small  doses  of  gr.  1-67  every  one  to 
three  hours  it  excites  peristalsis  and  intestinal  secretion  and  thus 
relieves  costiveness  and  habitual  constipation.  But  unless  carefully 
dosed  and  the  influence  of  habit  is  established,  the  doses  must  be 
increased  and  the  effect  is  not  curative.  As  a  cathartic  for  prompt 
and  free  action  the  dose  is  two  to  five  grains ;  best  given  with  a  full 
dose  of  potassium  bitartrate.  It  then  acts  in  two  hours.  Given  in 
glycerin  by  enema  the  dose  is  one  grain. 

Van  Renterghem  recommends  gr.  1-3  every  hour  for  an  adult. 

Burggraeve  advised  gr.  3-67  hourly  in  chronic  enteritis. 

JUGLANDIN. 

Standard  granules — Gr.  1-67,  gm.  .001;  gr.  1-6,  gm.  .01. 

Juglandin  is  a  resin  from  the  root  bark  of  Juglans  cinerea,  the 
common  butternut.  That  employed  by  French  dosimetrists  is  from 


JUGLANDIN  263 

Juglans  regia,  and  is  probably  identical.  As  supplied  by  Merck,  it 
is  in  the  form  of  a  brownish  powder,  of  a  saline  and  slightly  bitter 
taste,  little  soluble  in  water,  freely  in  alcohol,  not  at  all  in  ether. 

Juglandin  possesses  the  virtues  of  the  astringent  aromatic  bit- 
ters. It  is  a  mild  stimulant  to  the  alimentary  canal,  laxative,  in 
larger  doses  gently  cathartic,  causing  no  griping  or  subsequent 
weakness  of  the  intestine  (Felter  and  Lloyd).  It  closely  resembles 
rhubarb  in  stimulating  the  gastrointestinal  secretions  but  does  not 
have  the  subsequent  constipating  action  so  markedly.  The  above 
authors  recommend  it  in  colorectitis,  habitual  constipation  and  other 
intestinal  affections ;  atonic  dyspepsia,  indigestion  with  sourness  and 
flatulence;  tenesmic  burning,  fetid  diarrheas  and  dysenteries,  and 
intestinal  indigestion  with  irritation;  scrofula  and  chronic  skin  dis- 
eases with  vesicles  or  pustules;  as  a  cathartic  in  rheumatism  and 
chronic  respiratory  affections;  lumbago,  intermittent  and  remittent 
fevers  with  abdominal  congestion;  murrain  and  yellow  water  of 
horses. 

Specific  Indications. — Chronic  constipation,  gastrointestinal 
irritability  with  sour  eructations,  flatulence  and  either  diarrhea  or 
constipation ;  diarrhea  and  dysentery  with  tenesmus  and  burning 
fetid  discharges;  torpid  liver;  chronic  pustular  or  vesicular  skin 
diseases  freely  discharging ;  eczema. 

Ellingwood  says  it  influences  with  great  energy  the  liver,  small 
intestines,  colon  and  rectum,  increasing  the  formation  and  flow  of 
bile,  and  the  activity  of  the  intestinal  glands.  It  closely  resembles 
iridin.  He  considers  Juglandin  valuable  in  duodenal  catarrh,  with 
torpid  liver  and  jaundice,  in  small  doses  in  dysentery  and  bilious 
diarrhea,  and  in  intestinal  diseases  with  irritability,  hyperemia  and 
tendency  to  inflammation ;  chronic  constipation  if  dependent  on  de- 
fective elimination  of  bile,  the  stools  clayey  and  dry ;  eczema,  herpes 
circinatus,  impetigo,  pemphigus,  rupia,  prurigo,  molluscum,  lichen 
and  chronic  scaly  affections;  mucous  irritations  of  throat,  eruptions 
like  scarlatina,  noli  me  tangere,  scrofulous  glands,  congestion  and 
irritation  of  the  respiratory  and  gastric  mucosa;  nursing  sore 
mouth,  mouth  ulcers  with  constipation;  used  locally  and  internally 
for  chronic  ill-conditioned  ulcers,  stimulating  waste  and  improving 
nutrition. 

How  much  of  the  effects  of  this  remedy  as  above  described  may 
be  summed  up  in  the  remark  that  it  clears  out  the  fetid  contents  of 
the  bowel,  stimulates  a  healthier  secretion  of  the  alimentary  fluids 
throughout,  and  thus  puts  a  stop  to  the  toxemia  resulting  trom  the 


264  KOUSSEIN 

absorption  of  poisons  from  the  alimentary  canal.  The  eclectics  have 
made  many  true  observations  as  to  the  uses  of  such  remedies,  but 
they  seem  to  have  totally  failed  to  explain  their  effects,  or  to  grasp 
the  principle  that  explains  their  pathology,  and  the  success  of  their 
therapeutics. 

Van  Renterghem  found  he  required  two  to  three  centigrams 
twice  a  day — gr.  1-3  to  1-2 — to  produce  a  purgative  effect.  Besides 
its  purgative  qualities  he  credits  juglandin  with  special  value  in 
scrofula,  the  syphilitic  cachexia,  the  mercurial  dyscrasia,  chronic  in- 
testinal catarrh,  and  helminthiasis.  Used  after  mercury  it  is  cer- 
tainly beneficial,  without  possessing  any  specific  control  over  syphilis 
(Pearson).  Even  here  it  is  the  digestive  difficulties  that  are  rem- 
edied by  juglandin  and  that  constitute  the  indication  for  its  employ- 
ment (Posner).  Droixhe  counted  on  curing  75  per  cent  of  scrofulas 
with  this  agent;  which  acted  mildly,  with  few  relapses;  the  effects 
were  slowly  manifested,  especially  with  non-suppurating  glands ; 
the  local  effects  of  the  leaves  being  more  decided  than  the  internal 
administration;  especially  did  he  urge  it  as  the  best  treatment  of 
scrofulous  ophthalmias. 

Van  Renterghem  advises  doses  of  gr.  1-3  to  j  four  to  five  times 
a  day.  It  may  be  associated  with  santonin  for  worms,  mercury  for 
syphilis,  or  with  other  cathartics. 

KOUSSEIN. 

Standard  granules — Gr.  1-67,  gm.  .001 ;  gr.  1-6,  gm.  .01. 

Koussein  is  a  resin  derived  from  Brayera  anthelmintica,  a  tree 
of  Abyssinia.  It  is  yellowish  white,  partly  crystalline,  disagreeably 
bitter,  almost  insoluble  in  water,  quite  soluble  in  stronger  alcohol 
and  in  ether,  ammonia  and  caustic  alkalies.  Two  alkaloids  have 
been  found  in  kousso,  one  of  which  is  a  dangerous  paralyzant  of  the 
peripheral  muscles  and  those  of  respiration,  but  neither  has  been 
studied  closely.  Kusotoxin  also  paralyzes  the  heart.  It  causes 
dyspnea,  rapid  breathing,  salivation  and  vomiting.  In  large  doses 
kousso  causes  diarrhea  and  increases  the  urine.  It  seems  to  be  a 
general  protoplasmic  poison  (Cushny).  Given  in  pregnancy  kousso 
is  liable  to  cause  abortion. 

All  varieties  of  tape  worm  and  the  lumbricoid  also,  are  destroyed 
by  this  agent.  Kuechenmeister  found  that  they  died  in  half  an  hour 
when  placed  in  a  milky  infusion  of  kousso;  in  two  or  three  hours 
in  an  albuminous  mixture.  The  maceration  renders  it  difficult  to 
detect  the  head  of  the  worm. 


THERAPEUTIC   NOTES 


THERAPEUTIC    NOTES 


LECITHIN  265 

Jack  found  that  a  dose  of  1-2  ounce  caused  a  sensation  of  empti- 
ness of  the  stomach,  slight  nausea,  fatigue  and  dislike  of  work,  then 
gurgling  m  the  bowels,  and  after  an  hour  and  a  half  many  copious 
stools,  solid,  then  liquid.  There  was  no  headache  nor  vomiting, 
pains  in  the  stomach  or  difficulty  in  urinating,  symptoms  often  pre- 
sented by  those  who  have  taken  doses  of  six  drams  (Hasse,  Petit). 

Van  Renterghem  says  koussein  acts  even  against  ascarides.  He 
advises  never  to  give  a  tenicide  unless  the  sections  of  the  worm  have 
been  passed  and  are  recognized  by  the  physicians  as  such.  Of  the 
granules  containing  gr.  1-6  each  he  gives  an  adult  ten  every  quarter 
hour,  beginning  at  6  a.  m.,  and  after  the  fourth  dose  administering 
a  dose  of  castor  oil.  This  is  to  be  repeated  till  the  tenia  has  been 
expelled.  For  ascarides,  in  children  under  two  years  of  age,  he 
gives  gr.  1-3  each  of  koussein  and  santonin,  during  the  day.  For 
older  children  give  larger  doses.  Begin  each  day  with  an  intestinal 
lavage  with  saline.  Juglandin  should  be  added  if  there  are  evidences 
of  scrofula. 

Somewhere  we  have  read  that  in  Abyssinia  where  tenias  are 
considered  a  matter  of  course,  kousso  is  only  taken  as  a  means  of 
disciplining  the  parasite  when  he  becomes  troublesome,  not  with  the 
intention  of  destroying  him.  In  America  the  use  of  koussein  has 
been  almost  entirely  replaced  by  that  of  male  fern. 

LECITHIN. 

Standard  tablet — Gr.  i,  gm.  .065. 

In  1895,  Danilewsky  made  the  startling  discovery  that  lecithin, 
administered  to  growing  animals,  was  capable  of  stimulating  their 
growth.  He  administered  this  substance  to  three  young  rabbits,  all 
of  the  same  litter,  keeping  three  others  as  controls,  that  is,  giving 
these  no  lecithin.  He  found  that  the  animals  treated  with  the  leci- 
thin grew  nearly  twice  as  fast  as  those  that  had  not  been  so  treated. 
This  discovery  created  a  tremendous  sensation  at  the  time  and  was 
largely  responsible  for  the  latter-day  revival  of  organotherapy.  , 

In  the  use  of  lecithin  we  have  a  true  substitution  treatment ;  for, 
by  giving  this  substance,  we  supply  something  to  the  organism  that 
is  lacking  in  many  morbid  conditions.  Its  administration,  therefore, 
is  indicated  on  the  same  grounds  (in  the  conditions  to  be  enumerated 
below),  as  the  administration  of  thyroid  preparations  in  myxedema 
and  cretinism. 

Though  discovered  many  years  ago,  lecithin  for  a  long  time  com- 
manded only  strictly  scientific  interest.  This  was  due  to  the  fact 


266  LECITHIN 

that  it  could  be  manufactured  only  in  very  small  quantities  and  by  a 
very  complicated  process,  and  that  the  chemists  who  experimented 
with  this  body  were  laboratory  workers  and  not  clinicians. 

A  number  of  so-called  "lecithins"  have  been  made  from  the  yolk 
of  eggs.  Unfortunately,  it  appears  that  these  are  therapeutically 
not  so  active  as  the  lecithin  made  from  animal  tissues ;  the  explana- 
tion that  can  be  ventured  is,  that,  lecithin,  as  found  in  the  egg,  is 
really  an  inert  storage  body,  not  meant  to  be  utilized  until  the  chick 
embryo  begins  its  life  processes,  whereas  lecithin  made  from  animal 
tissue  (properly,  as  in  Neuro- Lecithin,  Abbott,  from  nervous  tis- 
sue), represents  a  product  that  is  living  at  the  time  the  animal  is 
killed,  and  does  not  die  with  it. 

Lecithin  is  universally  distributed  throughout  the  organic  world 
and  is  found  wherever  protoplasm  is  alive.  It  occurs  in  nature  al- 
ways combined  with  certain  albumins,  and  in  order  that  it  be  prop- 
erly assimilated  it  must  be  isolated  from  its  albuminoid  combina- 
tions. If  this  were  not  necessary  it  would  be  a  very  simple  matter 
to  administer  lecithin  in  the  form  of  yolk  of  egg  or  of  brain  sub- 
stance. As  a  matter  of  fact,  some  of  the  lecithin  preparations  on  the 
market  are  nothing  more  than  emulsions  of  yolk  of  egg.  Needless 
to  say  these  are  therapeutically  inert. 

In  administering  lecithin,  we  administer  phosphorus  in  true 
organic  combination.  It  has  been  the  aim  of  therapeutists,  for  a 
great  number  of  years,  to  find  a  phosphorus  compound  that  is  easily 
assimilated  and  properly  retained  by  the  tissues,  the  reason  for  this 
endeavor  being  that  in  all  wasting  diseases,  in  neurasthenia  and 
nervous  debility  of  all  kinds,  there  is  always  a  great  loss  of  organic 
phosphorus.  It  may  be  considered  a  clearly  recognized  postulate 
that  unless  this  phosphorus  is  replaced  the  organism  cannot  perform 
its  functions  in  a  normal  manner. 

At  first,  basing  their  therapy  on  this  idea,  clinicians  gave  certain 
inorganic  salts  of  phosphorus  as,  for  instance,  sodium  phosphate 
and  later  the  hypophosphites  of  sodium ;  then  certain  French  physi- 
cians, recognizing  that  in  lecithin  the  phosphorus  is  found  combined 
with  glycerin,  introduced  the  so-called  glycerophosphates  into  prac- 
tice; but  all  these  phosphorus  compounds  have  proved,  practically, 
to  be  therapeutic  failures  and  have  since  been  abandoned  by  con- 
servative therapeutists,  although  some,  unthinking,  adhere  to  their 
old-fashioned  prescriptions  even  to  this  day. 

In  lecithin  a  phosphorus  combination  has  at  last  been  found  that 


LECITHIN  267 

is  readily  assimilated  and  that  can  be  used  to  supply  phosphorus  to 
starved  nerve  tissues  whenever  they  cry  for  it. 

Therapeutics. — The  clinical  results  that  are  based  on  the  experi- 
mental investigations  with  lecithin  are  exceedingly  gratifying.  Aside 
from  the  fact  that  given  to  normal  infants  and  adolescents,  it  un- 
questionably hastens  their  growth  and  stimulates  more  rapid  de- 
velopment, it  is  an  understood  fact  that,  given  to  abnormal  children, 
and  to  those  suffering  from  marasmus  and  malnutrition,  it  (Neuro- 
Lecithin,  Abbott)  reestablishes  nutritive  equilibrium,  favoring 
growth  and  stimulating  normal  development. 

In  a  great  variety  of  nervous  disorders,  in  which  there  is  loss  of 
nerve  energy,  it  acts  as  a  reconstructor  of  nerve  tone  and  is  there- 
fore exceedingly  helpful. 

In  anemia  and  chlorosis,  it  stimulates  the  function  of  the  blood- 
forming  organs,  and  is  therefore  indicated. 

In  a  large  variety  of  functional  disorders  of  the  nervous  system 
and  in  those  disorders  of  metabolism  that  are  the  inevitable  result  of 
these  nervous  perversions,  lecithin  acts  with  remarkable  efficacy; 
thus,  in  diabetes,  and  in  the  uric-acid  diathesis,  both  diseases  that  are 
presumably  due  to  some  neurosal  defect,  it  has  been  given  with  ad- 
vantage. 

In  neurasthenia  and  in  a  variety  of  psychoses,  usually  classed  as 
"nervous  prostration,"  lecithin  has  also  been  most  successfully  em- 
ployed. 

There  is  one  other  disease,  in  particular,  in  which  lecithin  has 
been  found  to  be  of  great  value,  namely,  tuberculosis.  In  this  affec- 
tion there  is  always  great  loss  of  phosphorus  and  nitrogen,  owing 
to  the  destruction  of  the  patient's  tissues  by  fever  and  the  tubercu- 
losis toxin.  This  loss,  it  appears,  can  in  many  cases  be  replaced  by 
the  administration  of  lecithin  in  sufficiently  large  doses;  for  it 
stimulates  tissue-reconstruction  and  incidentally  supplies  the  needed 
phosphorus.  Many  clinicians  report  really  brilliant  results  from  the 
administration  of  this  preparation  in  the  treatment  of  the  early 
stages  of  tuberculosis,  and  it  is  tentative  at  any  stage. 

Lecithin  also  has  the  power  of  stimulating  leucocytosis  and  this, 
it  is  clearly  recognized,  is  the  best  and  most  efficient  means  of  com- 
bating any  acute  infectious  disease ;  and  in  convalescence  from  acute 
infectious  diseases  there  is  no  tissue-builder,  no  general  tonic,  like  it 
— alone  or  synergistic  to  the  Triple  Arsenates  with  Nuclein  (devised 
of  other  indicated  vital  incitants). 

It  is  also  said  to  be  a  most  efficient  remedy  in  functional  im- 


268  ,  LEPTANDRIN 

potency  and  in  premature  senility.  Lecithin  is,  therefore,  a  practical 
panacea  at  both  extremes .  of  life,  stimulating  the  young"  organism 
to  growth  and  preventing  premature  decay  in  the  old. 

LEPTANDRIN. 

Standard  granule — Gr.  1-6,  gm.  .01. 

Leptandrin  is  a  resin  from  Leptandra  Virginica,  or  Culver's 
root.  Lloyd  states  that  the  ordinary  leptandrin  is  inert,  the  hydro- 
alcoholic  extract  alone  carrying  with  it  the  virtues  of  the  plant. 

Lloyd  says  that  leptandra  acts  upon  the  stomach,  liver  and  in- 
testines; the  fresh  root  causing  dangerous  catharsis,  emesis,  dysen- 
tery, vertigo  and  in  pregnant  women  miscarriage.  On  drying  it  be- 
comes a  safe  and  reliable  cholagog,  laxative  and  cathartic.  In  small 
doses  it  does  not  physic  but  gently  stimulates  the  liver  and  the  func- 
tional activity  of  the  whole  intestinal  appendages.  It  favors  normal 
intestinal  excretion  and  improves  digestion.  Scudder  used  it  as  a 
gastrointestinal  tonic,  for  feeble  circulation  with  stasis.  It  acts  well 
in  intestinal  atony,  hepatic  torpor,  the  early  stages  of  fevers  and 
dysentery,  and  chronic  dysentery  and  enteritis  with  dizziness,  cold 
extremities,  headache,  abdominal  and  hepatic  pain  with  mental  de- 
pression. Stimulating  the  glandular  system  to  activity  it  is  useful 
in  chronic  catarrhs ;  for  indigestion  with  deficient  secretion  adding 
podophyllin,  for  acholic  stools  even  if  there  is  diarrhea;  dyspepsia 
with  frontal  headache,  yellow  tongue,  nausea,  jaundice;  for  gastric 
atony  combining  with  hydrastis ;  for  diarrhea  with  passage  of  un- 
digested food,  inactive  liver,  dull  abdominal  pain,  stools  clayey ;  in 
diarrhea  of  dentition ;  for  jaundice  with  tender  liver  add  rhubarb ; 
biliousness ;  acute  hepatitis  add  a  diaphoretic ;  occasional  dose  in 
chronic  hepatitis ;  after  passage  of  biliary  calculi,  with  hydrastis  to 
alter  the  conditions  giving  rise  to  the  concretions;  for  jaundice  add 
dioscorea,  chionanthus  or  chelidonium  ;  in  formative  stages  of  fevers, 
especially  bilious,  it  often  checks  the  morbid  process ;  in  typhoid  in 
malarial  districts ;  in  malaria  after  quinine  has  broken  the  chills ; 
dropsy,  hydrocephalus,  ascites  with  congested  liver  and  despond- 
ency; to  remove  fluid  and  prevent  accumulation. 

Specific  Indications. — Drowsiness,  dizziness  and  mental  de- 
pression with  tenderness  and  heavy  pain  in  liver ;  tongue  white,  skin 
yellow,  bitter  taste,  cold  extremities,  nausea,  dull  frontal  headache, 
thirst  with  inability  to  drink,  restlessness  with  insomnia;  diarrhea 
with  half-digested  passages  or  clayey  stools,  feeble  portal  circula- 
tion with  lassitude  and  mental  depression. 


LOBELIN  269 

As  a  purgative  leptandrin  should  be  given  in  doses  of  gr.  1-6 
every  hour,  or  six  times  this  at  once.  For  its  action  on  the  chronic 
affections  above  enumerated  give  gr.  1-6  every  two  hours,  or  a  grain 
at  bedtime.  It  should  not  be  forgotten  that  the  best  effects  of  this 
remedy  are  obtained  without  obvious  catharsis. 

LOBELIN. 

Standard  granule — Gr.  1-12,  gm.  .005. 

Lobelin  is  a  concentration  from  Lobelia  inflata",  Indian  tobacco. 
Lobelia  contains  an  alkaloid,  lobeline,  isolated  by  Procter,  a  liquid, 
described  by  King  as  acrid,  irritable  and  unstable.  The  salts  are 
stable.  It  is  soluble  in  alcohol,  chloroform,  and  somewhat  in  water. 
Lloyd  also  found  a  non-crystallizable  body  to  which  he  gave  the 
name  of  inflatin.  A  fixed  oil  is  also  extracted  from  the  seeds,  which 
contains  the  virtues  of  the  plant. 

Felter  and  Lloyd  say  that  lobeline  is  so  quick  an  emetic  that  it  is 
impossible  to  poison  with  it.  A  drop  of  an  alcoholic  solution  on  a 
man's  tongue  caused  instantaneous  vomiting.  Death  in  a  very 
prostrated  case  might  result  from  the  repeated  vomiting  but  not 
from  the  direct  action  of  lobelia.  When  the  drug  is  chewed  it  causes 
an  acrid,  pungent  sensation,  slight  nausea,  warmth  and  distention 
along  the  oesophagus  and  stomach,  the  salivary  and  buccal  glands 
secreting  freely;  then  epigastric  depression,  profound  nausea  and  if 
the  dose  is  large  enough,  severe  and  thorough  emesis.  Profuse 
perspiration  and  profound  depression  attend.  The  muscles  are  re- 
laxed, and  a  period  of  languor  follows.  The  depression  is  very 
short,  and  immediately  followed  by  a  sense  of  extreme  satisfaction 
and  repose.  The  mental  powers  are  unusually  acute.  The  circula- 
tion is  weakened  by  large  and  strengthened  by  small  doses.  The 
bronchial  secretions  are  increased.  If  emesis  does  not  occur,  purg- 
ing does.  If  death  results,  it  is  from  respiratory  paralysis. 

Lobelia  is  nauseant,  emetic,  expectorant,  relaxant,  antispasmodic. 
diaphoretic,  sialagog,  sedative,  occasionally  cathartic,  diuretic  and 
astringent.  It  is  in  no  sense  a  narcotic.  Temporarily  depressing,  its 
beneficial  after-effects  make  it  preferred -as  an  emetic  to  all  others. 
It  is  safer  and  more  effective  when  combined  with  ipecac.  It  is 
used  in  the  forming  stage  of  fevers,  with  sluggishness  and  heavily- 
coated  tongue ;  in  chronic  diseases  to  arouse  the  system  from  atony ; 
as  an  emetic  give  small  doses  in  warm  water  rapidly  repeated. 
Spasmodic  movement  is  incompatible  with  nervous  and  muscular 
relaxation.  Give  nauseant  doses  for  chorea,  tetanus,  children's 


270  LOBELIN 

worm  fits,  hysteric  and  infantile  convulsions,  epileptiform  and  other 
convulsions ;  it  is  the  remedy  for  rigid  os  uteri,  relaxing  the  peri- 
neum also;  best  for  a  thick,  doughy  os  (gelsemium  for  thin  knife 
edge)  ;  intestinal  obstructions,  strangulated  hernia,  intussusception, 
fecal  impaction;  asthmatic  paroxysms,  spasmodic  croup,  whooping- 
cough  ;  strychnine  poisoning ;  as  a  sympathetic  stimulant,  it  improves 
the  innervation  of  parts  supplied  by  the  pneumogastric  and  sym- 
pathetics,  useful  in  indigestion,  dyspepsia,  gastric  sick  headache, 
qualmishness  and  nausea,  intestinal  atony  and  habitual  constipation, 
with  podophyllin  for  costiveness,  increases  peristalsis,  small  doses 
relieve  infantile  colic ;  for  angina  pectoris,  cardiac  neuralgia  and  pul- 
monary apoplexy  it  is  the  drug;  best  remedy  for  markedly  slow 
pulse-wave,  with  precordial  oppression,  thoracic  pain,  difficult 
breathing,  soreness  in  chest,  nausea,  tongue  heavily  coated  at  base, 
and  fullness  of  tissue;  cardiac  congestion;  the  great  value  is  in 
respiratory  affections,  spasmodic  asthma,  whooping-cough,  conges- 
tions, pleurisy,  pneumonia  acute,  congestive,  breathing  oppressed, 
all  chronic'  sore  throats  especially  ulcerated,  chronic  pneumonia, 
bronchitis  and  laryngitis,  asthenic  laryngitis  of  children,  dry  hard 
and  barking  chronic  catarrhs,  coughs  and  colds,  all  respiratory  irrita- 
tions with  congestion  or  oppression,  the  full  oppressed  or  small 
feeble  pulse  with  oppression  anywhere  in  the  chest,  accumulated 
secretions  and  loud  mucous  rales;  retrocession  of  eruptions,  scarla- 
tina and  measles  with  tardy  eruption,  rhus  poisoning,  locally  in 
many  superficial  inflammations ;  and  in  erysipelas. 

Specific  Indications. — Full,  labored,  doughy  pulse,  blood  moves 
with  difficulty ;  heavy,  sore  oppressive  chest  pain ;  angina  pectoris, 
cardiac  neuralgia,  pulmonary  apoplexy;  mucus  accumulation  in 
bronchi,  convulsive  movements,  rigid  muscles  and  os  uteri  with 
thick  doughy  edges,  rigid  perineum  or  vaginal  walls,  nausea  and 
sick  headache,  as  emetic  for  tongue  heavily  coated  at  the  base. 

Ellingwood  places  lobelia  first  in  his  list  of  agents  acting  upon 
the  respiratory  tract.  He  terms  it  a  nerve  depressant  of  great  power. 
It  is  a  specific  in  irritable,  spasmodic  and  oppressed  breathing; 
threatened  spasm  with  exalted  nerve  action ;  high  nerve  tension 
with  great  restlessness  and  excitability,  flushed  face  and  contracted 
pupils ;  affects  children  less  than  adults ;  for  eclampsia  and  the 
spasms  of  hydrophobia ;  etc.  He  employs  lobelia  frequently  in  com- 
bination with  capsicum. 

The  foregoing  is  the  account  given  by  the  leading  authorities  in 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


LYCOPIN  271 

the  eclectic  school  of  this  remarkable  remedy  that  has  held  the  first 
place  with  them  for  nearly  a  century,  since  Thompson  introduced  it. 

Cushny  says  lobeline  increases  reflex  irritability ;  accelerating  the 
respiration  by  stimulating  the  centers  in  the  cord  and  medulla.  It  re- 
sembles nicotine  in  some  respects.  The  blood  pressure  at  first  falls, 
but  soon  rises  above  normal.  The  respirations  are  faster,  deeper 
and  stronger.  He  limits  its  therapeutic  use  to  nervous  asthma. 

Cornet  found  lobeline  sulphate  effective  in  the  spasmodic  cough 
of  phthisis,  and  giving  almost  magical  results  in  the  various  forms 
of  croup.  It  also  proved  useful  in  chronic  bronchitis,  asthma,  and 
the  convulsive  cough  of  pertussis. 

One  general  indication  for  its  use  seems  to  have  been  too 
slightly  advocated — that  of  loosening  secretions  in  catarrhal  mal- 
adies of  the  dry  type. 

The  dose  of  lobelin  is  from  gr.  1-12  to  1-2,  repeated  every  five 
minutes  to  thirty,  always  given  dissolved  in  hot  water,  as  the  gran- 
ules are  apt  to  pass  through  the  bowels  unchanged.  Thus  given  in 
smaller  doses,  lobelin  has  proved  quite  effective  in  costiveness  of 
very  young  infants. 

LYCOPIN. 

Standard  granule — Gr.  1-6,  gm.  .ox. 

Lycopin  is  a  concentration  from  Lycopus  Virginicus,  or  bugle 
weed. 

Felter  and  Lloyd  term  lycopus  a  certain  sedative,  mild  narcotic, 
sub-astringent  and  tonic.  Its  sedation  is  best  shown  when  the  heart 
is  tumultuous,  and  pulse  rapid  with  evident  lack  of  cardiac  power. 
It  is  useful  in  the  late  stages  of  acute  affections  with  great  debility 
and  in  chronic  cases  with  fast  pulse.  It  acts  somewhat  like  digitalis, 
controlling  excessive  vascular  excitement,  and  lessening  exalted 
organic  action.  It  improves  the  appetite,  reestablishes  normal  secre- 
tion, and  improves  blood  making  and  nutrition.  It  is  a  remedy  for 
morbid  vigilance  and  insomnia,  painful  and  distressing  indigestion, 
to  purify  the  blood  for  old  ulcers,  for  diabetes  mellitus,  albuminuria 
with  rapid  irritated  pulse;  frequent  small  hemorrhages,  such  as 
hemoptysis,  epistaxis,  hematuria,  uterine  and  intestinal  hemor- 
rhages ;  dysentery  and  diarrhea,  especially  of  phthisis,  soothing  in 
gastritis  and  enteritis  and  the  gastric  and  intestinal  affections  of 
drunkards  and  of  malaria;  inflammations  of  the  heart,  palpitation, 
with  irritability  and  irregularity  with  dyspnea  and  oppression; 
dilated  and  hypertrophied  hearts,  relieving  the  suffering  and 


272  MACROTIN 

anxiety;  exophthalmic  goiter;  acute  and  still  more  in  chronic  lung 
ails,  a  gentle  sedative  and  tonic,  for  irritation  and  cough  with 
tendency  to  hemorrhage,  relieves  cough  of  chronic  bronchitis, 
pneumonia  and  consumption,  giving  rest  and  quieting  pain,  acute 
catarrhs ;  for  pulmonary  hemorrhage  with  cinnamon  and  ipecac  the 
best  of  remedies. 

Specific  Indications. — Vascular  excitement,  small  hemorrhages 
from  determination  of  blood  to  lungs,  kidneys  or  gastrointestinal 
organs ;  albuminuria  with  fast  pulse ;  debilitating  chronic  cough  with 
free  sputa;  wakefulness  and  morbid  vigilance  with  too  active  cir- 
culation ;  fast  pulse  with  high  fever,  and  in  tuberculosis. 

Ellingwood  looks  for  the  specific  effects  of  lycopus  in  heart  af- 
fections with  irritability  and  irregularity,  dyspnea  and  oppression. 
It  has  succeeded  in  incipient  phthisis,  and  hemoptysis ;  high  fever  of 
typhoid  fever;  promotes  digestion  and  invigorates  the  appetite. 

The  dose  of  lycopin  is  from  gr.  y2  to  2  before  each  meal  and  at 
bedtime. 

MACROTIN. 

Standard  granule — Gr.  1-6,  gm.  .01. 

Macrotin  is  a  resinoid  from  Cimicifuga  racemosa,  or  black 
cohosh. 

Shoemaker  says  that  cimicifuga  in  small  doses  stimulates  the 
digestion,  increasing  the  gastrointestinal  secretions.  It  also  in- 
creases the  bronchial  mucus,  and  the  urine,  and  strengthens  the 
heart.  The  effect  on  the  circulation  resembles  that  of  digitalin  b:it 
is  less  powerful.  Brunton  styles  it  a  succedaneum  for  ergot.  Full 
doses'  slow  the  pulse  and  increase  its  force,  raise  vascular  tension, 
and  stimulate  contractions  of  the  uterus.  It  lowers  the  reflex  ex- 
citability of  the  cord,  dilates  the  pupils,  and  dimness  of  vision, 
vertigo,  intense  headache,  nausea  and  vomiting  result  from  too 
large  doses.  Hypnotic  effects  have  been  reported,  with  relief  from 
pain  and  spasm.  Death  may  be  caused  by  paralysis  of  respiration. 

Lloyd  says  cimicifuga  acts  also  upon  the  skin,  imparting  its 
earthy  odor  to  the  urine;  small  doses  given  hourly  produce  symp- 
toms closely  simulating  those  of  delirium  tremens ;  green  tea  is 
said  to  counteract  the  narcotic  effects ;  cimicifuga  increases  the 
menstrual  flow  and  possibly  the  venereal  appetite. 

Felter  and  Lloyd  credit  this  remedy  with  decided  values  in  rheu- 
matism and  neuralgia;  muscular  rheumatism,  lumbago,  torticollis, 
acute  non-spinal  pains  such  as  gastralgia,  enteralgia,  tenesmus  of 


MACROTIN  273 

bladder,  pleurodynia,  mediastinal  pain,  orbital  and  aural  pains,  eye 
strain  with  affection  of  ocular  muscles;  acute  conjunctivitis;  rheu- 
matoid dyspepsias,  with  dull  pain  and  tendency  to  metastasis  worse 
on  taking  food  or  drink,  stomach  walls  feeling  as  if  contracting  on 
a  hard  substance,  with  rheumatic  history;  atony  of  reproductive 
tract,  pains  from  imperfect  menstruation,  suppressed  and  especially 
non-established  menses,  unsurpassed  in  dysmenorrhea ;  best  in  irrita- 
tion and  congestion  of  uterus  and  appendages,  tensive  dragging 
pains,  like  rheumatism ;  if  despondent  and  chilly  add  pulsatilla,  espe- 
cially in  anemics ;  if  opposite,  add  gelsemium ;  for  reflex  side-aches 
of  virgins,  mastitis  and  mastodynia ;  uterine  rheumatism  and  leucor- 
rhea ;  sterility  from  uterine  atony,  reflex  mammary  pains  during 
gestation,  ovaralgia,  neuralgia,  orchialgia  and  aching  prostate,  and 
as  a  tonic  in  spermatorrhea ;  excels  ergot  in  parturition  by  producing 
natural  pains,  an  excellent  partus  praeparator  if  given  for  some 
weeks  previous  to  confinement,  dissipating  false  pains  and  strength- 
ening true  ones,  the  best  remedy  for  after-pains  and  allays  the  nerv- 
ous excitement  following  labor;  for  nervous  cases,  useful  in  chorea, 
best  when  menses  are  deficient,  as  an  antispasmodic  in  hysteria, 
epilepsy  due  to  amenorrhea,  asthma,  periodic  convulsions,  nervous 
excitability,  whooping-cough,  delirium  tremens  and  other  spasms ; 
headache  from  cold  or  congestive,  neuralgia,  dysmenorrhea  or  in- 
fluenza ;  in  phthisis  lessens  cough,  soothes  pain,  especially  sub- 
scapular  aching,  lessens  secretion  and  allays  nervousness ;  malarial 
fevers  are  benefited  by  its  tonic  power;  for  rheumatic  fever  add 
acopite  or  veratrum ;  prompt  and  decisive  in  cerebral  complications 
of  eruptive  fevers ;  especially  in  children,  and  in  simple  fevers ;  les- 
sens the  force  and  frequency  of  the  pulse,  soothes  pain,  allays  ir- 
ritability, and  lessens  cerebral  irritability  and  the  tendency  to  con- 
gestion ;  in  fevers,  especially  exanthemata,  it  often  causes  diaphoresis 
and  diuresis,  controls  pain  like  the  bone-ache  of  smallpox,  renders 
the  attack  milder,  relieves  the  headache  and  backache  preceding  the 
eruption,  and  has  been  thought  prophylactic  against  smallpox;  has  a 
tonic  influence  over  serous  and  mucous  tissues,  and  is  a  superior 
remedy  in  their  chronic  maladies ;  add  alkalies  for  acidity  of 
stomach ;  often  relieves  promptly  pains  that  have  existed  long ; 
locally  it  is  applied  for  neuritis,  neuralgia,  tic,  spinal  inflammation, 
periodic  cephalic  pain,  ovaritis,  spasms  of  the  broad  ligaments, 
rheumatism,  crick  in  the  back  or  side,  ocular  inflammations,  and 
old  ulcers.  Preparations  from  recently  dried  roots  are  preferred ; 
in  phthisis,  cough,  acute  rheumatism,  neuralgia,  scrofula,  phlegmasia 


274  MENISPERMIN 

dolens,  amenorrhea,  dysmenorrhea,  leucorrhea  and  other  uterine  af- 
fections, the  alcoholic  preparations  are  urged  alone. 

Specific  Indications. — Muscular  pains;  uterine  pains  with  tender- 
ness, false  pains,  irregular  pains,  uterine  rheumatism,  dysmenor- 
rhea; as  an  antirheumatic  when  pulse  is  open,  pain  paroxysmal,  skin 
not  dry  and  constricted  (Scudder).  To  these  add  soreness,  drag- 
ging pains  in  hips  and  loins,  rheumatoid  muscular  pains  and  dys- 
pepsia, chorea  with  absence  of  menses.  Ellingwood  says  an  over- 
dose is  promptly  signalled  by  the  appearance  of  the  characteristic 
headache,  of  bursting,  tearing  character,  with  injected  conjunct! vac 
and  flushed  face;  which  abates  when  the  remedy  is  suspended.  He 
considers  muscular  aching  the  specific  indication  for  cimicifuga.  It 
is  the  remedy  for  hysteria  with  flushed  face  and  hot  head,  restless 
nervous  excitement  and  general  muscular  aching.  He  also  gives 
it  for  angina  pectoris,  functional  irregularity  of  the  heart,  cough  of 
excessive  nervous  irritation,  reflex,  irritable  or  acute  bronchitis ; 
lithemia,  sciatica,  dysmenorrhea  and  amenorrhea  with  aconite  if 
from  sudden  cold,  pulsatilla  if  from  nervous  shock  or  functional  ir- 
regularity of  long  standing,  helonias  if  with  weight  and  dragging 
in  lower  abdomen,  and  in  all  these  it  is  better  if  leucorrhea  is  pres- 
ent. It  is  useful  in  male  gonorrhea  with  aching  in  bladder  and  kid- 
neys ;  with  aconite,  gelsemium,  or  hydrangea. 

Shoemaker  recommends  cimicifuga  in  the  menstrual  disorders 
of  young  girls  at  puberty.  Simpson  used  it  for  hypochondria  and 
melancholy,  and  Ringer  in  rheumatoid  arthritis.  In  weak  and  fatty 
heart  Shoemaker  pronounces  it  safer  than  digitalis. 

Lloyd,  who  never  has  a  good  word  for  the  older  eclectic 
resinoids,  prefers  the  fluid  preparations ;  but  Ellingwood  says 
cimicifugin,  or  macrotin,  fully  represents  the  remedial  virtues  of 
the  plant. 

The  dose  of  macrotin  is  from  gr.  1-6  to  i  every  hour  in  acute  or 
painful  affections  till  relief  or  the  headache  described  by  Ellingwood, 
or  nausea,  results.  In  chronic  maladies  the  dose  should  be  thus  as- 
certained and  it  may  then  be  so  distributed  that  four  daily  doses  are 
taken,  one  before  each  meal  and  one  at  bedtime. 

MENISPERMIN. 

Standard  granule — Gr.   1-6,  gm.  .01. 

Menispermin  is  a  concentration  from  Menispermum  Canadense, 
or  yellow  parilla.  The  plant  contains  two  alkaloids,  berberine,  and 


MENTHOL  275 

menispermine,  or  menispine  according  to  Maisch.  The  latter  seems 
to  closely  resemble  berberine  in  its  action. 

Felter  and  Lloyd  say  that  menispermum  is  tonic,  laxative,  altera- 
tive and  diuretic.  From  medium  doses  a  slight  increase  in  the 
volume  of  the  pulse  is  evident,  and  the  appetite  is  increased  as  well 
as  the  bowel  action.  Excessive  doses  cause  purging  and  vomiting 
but  no  other  effects.  Menispermum  is  a  superior  laxative  bitter. 
It  is  probably  of  value  in  leucocythemia,  especially  when  the  spleen 
is  affected. 

Specific  Indications. — Skin  brown,  tongue  coated  at  base,  tip 
red,  irregular  appetite,  constipation  (Scudder). 

This  plant  has  had  some  repute  as  a  remedy  for  scrofulous  affec- 
tions, but  it  seems  probable  that  all  its  virtues  may  be  explained  by 
the  presence  of  berberine,  and  that  that  alkaloid  will  usefully  replace 
the  plant. 

The  dose  of  menispermin  is  a  grain  three  to  ten  times  a  day. 

MENTHOL. 

Standard  granule — Gr.  1-12,  gm.  .005. 

Menthol  is  a  camphoraceous  body  derived  from  oil  of  mint,  that 
in  the  market  being  mainly  from  a  Japanese  oil.  It  is  used  ex- 
ternally for  many  purposes,  but  little  internally.  But  as  it  may  with 
propriety  replace  the  old  carminatives,  it  is  well  that  we  should  be 
prepared  to  recognize  any  effects  coming  from  this  body,  physi- 
ologic or  toxic.  Menthol  so  closely  resembles  camphor  in  its  in- 
ternal effects  that  the  description  of  either  will  apply  to  the  other. 

Menthol  is  a  local  irritant  and  when  swallowed  causes  a  feeling 
of  warmth  in  the  stomach  and  coldness  in  the  throat  and  mouth. 
Large  doses  cause  nausea  and  vomiting;  headache,  confusion  and 
excitement  with  slow  pulse  and  flushed  skin.  There  may  be  hilarity, 
delirium,  hallucinations,  restlessness,  or  motor  excitement  passing 
into  convulsions.  Periods  of  quiet  alternate  which  increase  until 
coma  is  present.  Sometimes  this  occurs  without  the  period  of  ex- 
citement. The  spinal  cord  is  depressed,  the  reflexes  depressed,  by 
very  large  doses.  The  convulsions  are  due  to  stimulation  of  the 
cerebrum.  The  heart  is  slowed  somewhat,  the  vascular  tension 
raised,  the  capillaries  of  the  skin  dilated,  the  respiration  slowed  and 
deepened  slightly,  normal  temperature  unaffected  but  fever  lowered. 

Menthol  possesses  considerable  antiseptic  power,  and  stops  the 
movement  of  leucocytes.  It  is  excreted  by  the  kidneys  combined 
with  glycuronic  acid. 


276  MERCURY 

Menthol  has  proved  useful  for  the  vomiting  of  pregnancy.  It 
may  be  given  for  gastric  pains  and  colics,  flatulence,  in  fact  for  the 
whole  line  of  affections  in  which  a  carminative  is  indicated. 

The  dose  is  gr.  1-12  to  1-4,  repeated  every  five  minutes  till  relief 
ensues ;  and  best  given  dissolved  in  alcohol,  ether  or  chloroform,  and 
then  diffused  through  a  little  hot  water.  The  tablets  should  not  be 
swallowed  undissolved,  as  they  may  irritate  the  stomach.  Fermenta- 
tion in  the  stomach  is  usually  stopped  promptly  by  a  small  dose — gr. 
1-12 — of  menthol  repeated  quite  often. 

MERCURY. 

Standard  granules— Mercury  bichloride  gr.  1-134.  grn.  .0005;  mercury 
biniodide  gr.  1-67,  gm.  .001;  mercury  cyanide  gr.  1-134,  Sm-  -0005;  mercury 
protoiodide  gr.  1-6,  gm.  .01;  gr.  1-2,  gm.  .03;  mercury  salicylate  gr.  1-12,  gm. 
.005;  mercury  with  chalk  gr.  1-6,  gm.  .01 ;  calomel  gr.  1-67,  gm.  .001 ;  gr.  i-io, 
gm.  .006;  gr.  1-6,  gm.  .01;  gr.  1-2,  gm.  03;  gr.  i,  gm.  .06;  calomel  and  capsi- 
cum gr.  2,  gm.  .12;  calomel  and  ipecac,  gr.  1-8,  gm.  .00013;  calomel  ipecac,  and 
soda  err.  i-io,  gm.  .006;  calomel  and  iridin  gr.  1-6,  gm.  .01;  calomel  and  soda 
gr.  i,  gm.  .06. 

Acute  mercurial  poisoning  is  generally  due  to  corrosive  sub- 
limate. When  swallowed  it  at  once  causes  burning  pain  in  the 
mouth,  throat  and  stomach ;  nausea,  and  vomiting  of  bloody  shreds 
of  membrane;  diarrhea,  violent  tenesmus,  dysenteric  stools,  with 
evidences  of  collapse — small  weak  thready  pulse,  shallow  rapid 
respiration,  cold  clammy  sweat,  sunken  eyes,  the  voice  may  sink  to 
a  husky  whisper,  the  face  pinched.  There  are  no  constant  cerebral 
symptoms.  The  face  is  anxious  and  denotes  the  pain  from  which 
the  patient  suffers,  which  is  that  of  acute  gastritis.  The  urine  be- 
comes scanty  or  stops ;  the  last  passed  containing  casts  and  albumin, 
sometimes  sugar.  Death  may  occur  within  an  hour  from  shock  but 
usually  comes  later,  when  the  patient  is  exhausted  by  the  continued 
action  of  the  poison.  If  the  poisoning  is  from  the  absorption  of 
dressings  the  corrosion  of  the  mouth  is  absent  but  the  other  symp- 
toms are  similar.  Salivation  and  its  sequences  occur  within  a  few 
days. 

In  chronic  poisoning  the  local  effects  are  wanting.  This  begins 
with  a  metallic  taste,  and  soreness  of  the  gums  and  tongue.  One  or 
more  teeth  feel  as  if  too  long,  and  are  tender  when  bitten  upon. 
The  breath  becomes  fetid,  the  buccal  mucosa  swollen  and  all  the 
glands  secrete  freely,  the  tongue  swollen  and  coated,  and  ulcers  ap- 
pear along  its  side  and  along  the  edges  of  the  gums.  If  continued, 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


MERCURY  277 

these  ulcers  spread  and  may  become  diphtheritic  or  gangrenous,  the 
teeth  loosen  and  fall  out,  and  necrosis  may  extend  to  the  maxillary 
bones.  Some  rise  of  temperature  is  usual.  The  appetite  fails,  diar- 
rhea may  occur,  erythema,  urticaria,  eczema,  albuminuria,  glyco- 
suria,  disturbances  of  menstruation,  cachexia,  are  symptoms  ob- 
served in  more  or  less  frequency.  Workers  in  mercury  are  liable  to 
erethism,  tremor,  neuritic  pains,  anesthesias,  affections  of  the  eyes 
or  ears,  local  palsies,  etc. 

Physiologic  Action. — Taken  continuously  in  doses  short  of  toxic, 
mercury  stimulates  all  the  faculties,  physical  and  mental.  All 
the  glandular  secretions  and  excretions  are  stimulated,  the  processes 
of  metabolism  hurried,  the  appetite  enormous,  the  sexual  desire  and 
power  increased,  and  all  the  bodily  and  mental  functions  stimulated. 
In  fact,  the  patient  feels  that  he  is  living  at  a  rapid  rate,  and  using 
up  his  vitality  fast.  The  great  stimulation  of  the  lymphatics  oc- 
casions a  rapid  absorption  and  excretion  of  morbid  products,  and 
there  is  a  curious  feeling  of  internal  "cleanness,"  a  sense  of  new 
birth,  experienced.  With  this  comes  a  sense  of  capacity  for  great 
things.  This  description  is  based  on  the  experiences  of  a  colleague, 
who  became  accidentally  inoculated  with  syphilis,  unsuspected  until 
constitutional  symptoms  appeared.  He  was  then  placed  on  mercury 
and  kept  as  close  to  the  toxic  dose  as  possible  without  actually  touch- 
ing it,  for  a  year.  When  soreness  of  a  tooth  appeared  the  dose 
was  slightly  lowered  till  the  soreness  ceased,  and  after  a  few  days 
slowly  raised  again.  The  theory  on  which  this  use  of  mercury  is 
based  is  as  follows :  This  drug  causes  disintegration  of  the  normal 
tissues  when  given  in  toxic  doses.  The  syphilitic  tissues  which  con- 
tain the  specific  cause  of  the  disease,  are  liable  to  spontaneous 
death,  and  hence  are  more  liable  to  be  destroyed  by  mercury  than 
the  sound  tissues.  The  art  of  administering  mercury  then  consists 
in  giving  such  a  dose  as  will  destroy  syphilitic  growths  without  be- 
ing strong  enough  to  break  down  normal  cells.  For  this  purpose 
ascertain  what  dose  will  produce  the  slightest  tangible — that  is  toxic 
-  effects,  and  keep  just  below  it.  The  medication  should  be  kept 
up  as  long  as  there  is  any  visible  evidence  of  the  malady  remaining 
and  for  at  least  three  months  more;  and  after  this  resumed  when- 
ever any  symptom  of  the  disease  appears.  By  this  means,  and  this 
alone,  the  writer  believes  that  syphilis  may  be  radically  cured.  The 
treatment  should  be  instituted  the  moment  the  diagnosis  is  satisfac- 
torily made. 

Mercury  is  eliminated  through  the  kidneys,  the  intestines,  and  to 


278  MERCURY 

some  extent  by  all  the  emunctories.  It  passes  to  the  mother's  milk, 
and  through  her  blood  to  the  fetus  in  utero.  It  has  been  detected  in 
the  urine  a  day  after  its  administration  began,  and  six  months  after 
it  had  been  stopped.  The  form  of  mercury  for  use  in  syphilis  is  a 
matter  of  individual  preference,  all  forms  being  efficient.  The 
writer  prefers  the  iodides  because  they  are  more  easily  eliminated 
than  other  mercurials,  and  may  be  combined  with  other  iodides,  of 
iron,  calcium  and  arsenic,  when  desired. 

Salivation  may  be  prevented  by  keeping  the  teeth  in  order,  with 
brush  and  the  aid  of  the  dentist,  and  by  using  atropine  when  the 
danger  point  has  been  passed  accidentally.  Much  of  the  local  dis- 
ease in  the  mouth  is  due  to  the  elimination  of  mercury  there,  and  is 
easily  preventable. 

Therapeutics. — Mercury  was  long  used  as  an  antiphlogistic  in  all 
fevers  and  inflammations,  but  under  the  attacks  of  Thomson  and 
Reade  it  became  unpopular  and  fell  into  disuse.  It  was  restricted 
to  serous  inflammations,  and  then  to  iritis,  where  it  is  still  employed. 
We  may  see  a  revival  of  this  use  any  day.  The  old  physicians  were 
a  unit  in  asserting  that  when  the  constitutional  effects  of  mercury 
were  manifest  the  inflammation  was  obviously  undergoing  resolu- 
tion. The  dependence  of  disease  upon  microorganisms  and  the 
superlative  powers  of  mercury  as  a  germicide  have  given  the  neces- 
sary excuse  for  a  revival  of  the  practice.  Calomel  is  still  employed 
as  a  cholagog  purgative,  and  now  given  in  doses  of  gr.  1-12  to  1-6 
every  hour  till  a  grain  is  taken,  followed  by  a  saline  laxative.  It  is 
specially  indicated  when  the  stools  are  white  and  acholic,  fetid.  A 
certain  sense  of  well-being  follows  mercurial  purgation  that  does 
not  ensue  when  other  purges  are  employed  alone.  But  the  habitual 
use  of  calomel  in  this  way  is  not  advisable. 

As  an  intestinal  antiseptic  calomel  is  still  used  in  typhoid  fever, 
since  Wunderlich  showed  that  the  results  of  other  treatment  were 
better  when  a  preliminary  dose  or  two  of  calomel  had  been  given. 
Five  to  ten  grains  are  here  advisable.  The  benefit  arises  from  clear- 
ing the  bowels  of  their  decomposable  contents.  In  most  febrile 
maladies  this  is  good  practice. 

As  a  diuretic  calomel  was  given  with  squill  and  digitalis,  and 
possesses  unquestionable  value.  Especially  in  cardiac  dropsies  it 
is  of  use,  to  clear  the  tissues  of  encumbering  fluid  while  more  ra- 
tional measures  are  employed  to  prevent  reaccumulation,  such  as 
the  dry  diet.  A  grain  of  calomel  with  digitalin  gr.  1-67  to  1-22,  and 


MORPHINE  279 

scillitin  in  the  same  dose,  may  be  given  every  four  hours  for 
four  doses. 

Especially  in  opening  the  treatment  of  malarial  fevers  is  the 
calomel  purge  indicated,  followed  by  salines  or  purges  of  the 
jalapin  series. 

For  children,  the  ill-temper,  muddy  complexion  and  coated 
tongue,  with  indigestion,  have  been  considered  indications  for 
calomel,  which  is  always  beneficial;  but  any  laxative  like 'rhubarb 
or  juglandin,  followed  by  antiseptics,  does  the  work  as  well  and 
without  the  danger. 

Mercury  bichloride  is  of  value  in  dysenteries,  in  doses  of  gr. 
1-134  every  one  to  three  hours. 

Mercury  with  chalk  is  an  old  favorite  for  children. 

Mercury  is  contraindicated  by  the  cachectic  state,  general  de- 
bility, anemia  not  syphilitic,  feeble  digestion,  tuberculosis  possibl} 
though  this  is  denied,  nephritis  especially  if  elimination  is  defective, 
and  when  iodine  is  being  taken  or  used.  Pregnancy  is  usually  a 
contraindication. 

In  acute  poisoning  evacuate  the  stomach  thoroughly.  If  there  is 
no  stomach  tube  at  hand,  give  the  two  powders  of  a  seidlitz  or  soda 
powder  in  succession,  so  as  to  mix  and  effervesce  in  the  stomach, 
which  will  answer  the  purpose  well  and  without  nausea.  Tannic 
acid  or  any  drug  containing  it  may  be  given  to  render  the  mercury 
less  soluble,  and  eggs,  milk  or  any  albuminous  substance  to 
neutralize  it. 

For  chronic  poisoning  evacuate  the  stomach  and  bowels,  stop 
the  mercury,  use  astringent  antiseptic  mouth  washes,  with  atropine 
enough  to  keep  the  mouth  dry,  and  eliminate  by  iodides  given  to 
saturation.  At  first  this  will  render  the  mercury  in  the  body  soluble 
and  active,  and  it  is  not  to  be  given  as  long  as  active  symptoms  of 
the  poison  are  present.  The  generally  advocated  potassium  chlorate 
is  inferior  to  solutions  of  hydrastine,  a  grain  to  the  ounce,  or  of 
tannic  acid,  or  any  of  the  volatile  oils.  Careful  cleanliness  is 
essential. 

MORPHINE. 

Standard  granules — Hydrobromate,  gr.  1-67,  gm.  .001 ;  hydrochlorate,  gr. 
1-67,  gm.  .001;  hydrochlorate,  gr.  1-12,  gm.  .005;  sulnhate,  gr.  1-67,  gm.  .001; 
sulphate,  gr.  1-12.  gm.  .005. 

Morphine  is  derived  from  opium,  the  "concrete  juice  of  the 
Papaver  somniferum."  It  exists  in  opium  in  proportions  varying 


280  MORPHINE 

from  2.7  per  cent  to  22.8  per  cent  in  combination  with  many  other 
alkaloids,  which  also  exist  in  widely  differing  proportions,  and 
whose  effects  vary  through  the  whole  gamut  of  action  from  pure 
depression  to  pure  stimulation.  While  the  general  effects  of  opium 
are  apt  to  approximate  those  of  morphine  they  may  prove  to  be  ex- 
actly the  opposite;  and  this  exceptional  condition  may  appear  at  a 
time  when  life  hangs  in  the  balance.  For  these  reasons  and  others, 
the  medical  profession  has  to  a  great  extent  dropped  the  use  of  the 
galenic  opiates  and  employs  morphine  instead. 

Physiologic  and  Toxic  Actions. — Morphine  causes  first  a  depres- 
sion of  the  voluntary  movements,  later  marked  increase  in  reflex  ex- 
citability; drowsiness  ensues,  passing  into  sleep,  that  after  small 
doses  being  rather  a  state  of  quiet;  the  patient  may  be  easily 
aroused.  This  state  is  accompanied  in  some  cases  by  a  sense  of 
well-being,  termed  euphoria,  and  this  is  exceptionally  of  such  de- 
lightful quality  that  the  patient  once  experiencing  it  craves  a  repeti- 
tion. A  woman  to  whom  I  once  gave  a  hypodermic  of  morphine 
told  me  she  felt  as  if  floating  on  clouds  of  bliss.  To  the  majority  no 
such  sensations  come.  The  drug  is  to  the  intellect  a  paralyzant  from 
first  to  last.  At  first  it  is  the  reason  and  judgment  that  are  par- 
alyzed, the  self-consciousness  is  subdued  while  the  fancy  is  unaf- 
fected, so  that  the  patient  may  shine  in  conversation  and  astonish 
those  who  only  knew  him  when  fettered  by  timidity  or  a  sense  of 
propriety.  With  larger  doses  the  coherence  of  thought  becomes 
confused,  the  sense  of  time  is  weakened  but  not  so  markedly  as  with 
cannabis,  and  somnolence  comes  on  as  the  drug  affects  the  sensorium 
more.  Dreams  follow,  of  pleasant  form  at  first,  but  later  of  fright- 
ful nature. 

Still  larger  doses  cause  deep  sleep,  from  which  the  patient  is 
with  the  more  difficulty  aroused  as  the  doses  rise.  Finally  the  state 
becomes  that  of  coma,  the  respiration  sinks  in  frequency,  the  pulse 
is  good,  pupils  contracted  to  a  pin  point,  face  purple  and  congested, 
skin  warm  but  axillary  temperature  below  normal,  and  the  nose  be- 
comes raw  with  the  rubbing  to  relieve  itching.  The  respirations 
weaken  and  may  assume  the  Cheyne-Stokes  form.  Cyanosis  creeps 
in,  the  pulse  becomes  faster  and  weakens,  and  the  pupils  dilate  just 
before  death,  which  is  from  arrest  of  respiration,  the  heart  beating 
feebly  after  death. 

After  remedial  doses  of  morphine  the  patient  awakes  with  head- 
ache, dullness,  the  digestion  stopped  and  appetite  lost,  the  mental 


MORPHINE  '281 

faculties  sluggish.  Delirium  and  convulsions  may  occur  as  idiosyn- 
crasies, or  as  evidence  of  defective  renal  elimination. 

The  depression  of  morphine  is  exerted  first  on  the  brain,  the 
stimulation  on  the  cord.  Large  doses  are  requisite  to  produce  the 
latter.  Small  doses  often  assuage  or  remove  the  pains  of  disease 
without  destroying  consciousness.  Sudden  shocks  are  felt  when  the 
same  injury  gently  made  will  be  unnoticed.  Small  doses  have  little 
effect  on  the  motor  cerebral  centers  while  large  doses  lower  or 
abolish  their  irritability.  Cutaneous  sensation  is  lessened.  The 
vascular  pressure  is  high,  the  arteries  of  the  skin  of  the  head  and 
neck  dilated,  and  perspiration  is  increased.  As  asphyxia  advances 
the  pressure  varies,  though  if  artificial  respiration  is  kept  up  this 
effect  is  absent.  The  respiratory  center  is  paralyzed  before  the 
centers  for  cardiac  inhibition  and  vasoconstriction  are  much  affected. 
The  peripheral  muscles  and  nerves  are  only  affected  by  lethal  doses. 
The  secretions  are  lessened,  except  when  nausea  occurs  when  the 
saliva  and  perspiration  are  increased.  The  urine  is  often  retained 
in  the  bladder. 

Morphine  checks  the  movements  of  the  stomach  and  bowels,  as 
well  as  the  intestinal  secretions,  and  constipates.  The  excretion  of 
carbonic  acid  is  lessened,  lactic  acid  increases,  and  glycogen  disap- 
pears from  the  liver.  Sugar  may  appear  in  the  urine. 

Morphine  is  excreted  mainly  in  the  saliva,  gastric  juice,  intestinal 
fluids,  and  by  the  kidneys.  It  appears  in  the  stomach  2_J^  minutes 
after  injection  hypodermically,  and  ceases  to  appear  there  after  an 
hour.  Some  of  it  may  be  oxidized  in  the  body. 

Therapeutics. — The  place  occupied  by  morphine  is  peculiar.  Like 
alcohol  it  does  a  great  many  things  and  does  them  well ;  but  there 
are  few  if  any  uses  to  which  this  drug  is  put  that  may  not  be  better 
accomplished  by  some  one  or  other  of  the  agents  in  the  hands  of  the 
Alkalometrist.  It  is  safe  to  say  that  morphine  will  be  employed 
much  less  frequently,  as  the  physician  becomes  familiar  with  the  use 
of  definite,  uniform  agents,  and  acquires  a  liking  for  a  certain  nicety 
of  applying  his  therapeutics.  Morphine  and  alcohol  are  the  standbys 
of  the  lazy  doctor. 

As  a  reliever  of  pain,  morphine  acts  quickly  and  powerfully.  The 
pain  of  imprisoned  pus  or  strangulated  tissue  requires  quick  surgical 
relief  instead  of  drugs.  The  writer  was  once  called  from  his  bed 
to  see  a  man  whose  testicle  he  had  strapped  with  adhesive  the  preced- 
ing day ;  and  fortunately  arrived  in  time  to  remove  the  straps  before 
the  death  of  the  strangulated  tissues.  It  was  an  object  lesson  as  to 


282  MORPHINE 

the  misuse  of  morphine  he  has  never  forgotten.  Spasmodic  pain  of 
all  sorts  is  better  relieved  by  hyoscyamine,  especially  by  the  triad  of 
this  with  glonoin  and  strychnine  arsenate,  than  by  morphine.  And 
this  applies  to  so  many  forms  of  pain  that  hyoscyamine  threatens  to 
dethrone  morphine  as  "Pain  King."  This  is  well  illustrated  by  the 
use  of  these  drugs  in  the  atrocious  pangs  of  gallstones.  Here  it  is 
the  custom  to  give  morphine  hypodermically.  No  relief  ensues,  and 
the  dose  is  repeated,  increased,  at  last  desperately  as  the  pain  neutral- 
izes the  drug;  till  at  last  the  stone  rolls  out  of  the  common  gall-duct 
into  the  intestine,  the  antagonism  of  the  pain  is  removed,  and  just 
then  the  last  huge  dose  of  morphine  comes  into  play,  and  the  patient 
is  narcotized.  The  same  holds  good  as  to  renal  calculi.  All  forms 
of  colic  are  better  treated  by  hyoscyamine  than  by  opiates.  Dys- 
menorrhea  requires  a  careful  differentiation  as  to  the  variety  and  the 
causes,  and  there  is  no  excuse  for  the  prescription  here,  which  has 
made  so  many  drug  fiends. 

No  form  of  headache  is  suitable  for  morphine.  Neuralgias  are 
better  relieved  by  atropine,  which  sends  the  blood  back  to  the  pale, 
shrunken  skin.  Many  of  them  are  toxemic,  and  require  stimulation 
of  elimination,  which  morphine  checks — though  by  locking  up  uric 
acid  and  checking  the  absorption  it  gives  temporary  relief. 

The  pains  of  inflammation  are  better  treated  by  aconitine,  heat 
or  cold  locally,  and  such  treatment  as  is  indicated  in  each  special 
case.  The  hot  water  bag  has  done  away  with  the  use  of  paregoric 
in  innumerable  cases. 

Rheumatism  calls  for  salicylic  acid,  syphilis  for  mercury  or 
iodides,  gout  for  colchicine,  etc.,  until  one  is  led  to  ask,  what  form 
of  pain  is  left  for  morphine?  The  writer  cannot  answer  this  query. 

Morphine  causes  sleep.  Sleep  is  so  pre-eminently  a  necessity  of 
the  human  body  that  it  is  impossible  to  prevent  it  for  more  than  a 
night  or  two,  even  by  the  infliction  of  severe  pain.  If  sleep  fails  to 
come  at  the  proper  time,  there  is  always  a  reason  for  it ;  and  the 
duty  of  the  physician  lies  in  ascertaining  and  removing  the  obstacle, 
instead  of  smothering  the  protest  of  outraged  nature  with  drugs. 
But  if  these  be  required,  morphine  is  of  all  hypnotics  the  most  ob- 
jectionable. It  does  not  cure  the  tendency  to  insomnia  but  confirms 
it,  so  that  the  patient  finds  himself  less  able  to  sleep  without  it  after 
every  dose.  It  invariably  begets  the  drug  habit  if  permitted.  It 
constipates  and  interferes  with  the  digestion  so  that  the  harm  is 
greater  than  the  benefit.  The  sleep  is  less  natural  and  refreshing 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


MORPHINE  283 

than  that  following  the  use  of  trional  and  sulphonal,  and  less  prompt 
and  refreshing  than  that  of  hyoscine. 

As  an  antispasmodic  morphine  cannot  compare  in  efficacy  with 
atropine,  and  in  many  cases  the  harmless  agents  of  the  valerian 
group  answer  the  purpose  as  well  or  better  and  without  the  objec- 
tions cited  above. 

Morphine  checks  peristalsis,  and  hence  is  given  often  for  diar- 
rheas and  dysenteries.  The  writer  saw  a  patient  once  die  of  dysen- 
tery although  the  stools  had  been  locked  up  with  opium.  He  learned 
then  that  the  discharges  do  not  constitute  the  chief  danger  in  bowel 
complaints.  The  first  indication  in  such  maladies  is  to  remove  from 
the  bowels  all  fermenting  and  irritating  substances  that  cause  and 
keep  up  discharges ;  then  give  rest  by  restricting  closely  the  ingesta. 
Excited  peristalsis  may  be  soothed  by  heat  externally  and  small  hot 
enemas,  by  bismuth  salts,  and  the  normal  secretions  re-established 
by  minute  doses  of  emetine  and  rhein  or  juglandin.  There  is  little 
good  but  much  harm  to  be  done  by  the  giving  of  opiates  in  intes- 
tinal maladies.  Sometimes  in  dysentery  very  small  doses  of  mor- 
phine may  be  admissible;  but  it  must  not  be  forgotten  that  narcotism 
is  most  readily  induced  here,  and  most  dangerous.  Generally  by 
locking  up  in  the  bowel  the  cause  of  the  irritation  morphine  in- 
creases and  prolongs  the  attack.  The  writer  has  known  a  morphine 
devotee  to  give  this  drug  for  a  diarrhea  set  up  by  nature  to  get  rid 
of  an  accumulation  of  scybala,  which  condition  was  continued  for 
months  by  giving  morphine  at  every  indication  of  bowel  action. 
A  few  doses  of  oil  and  enemas  cured  the  affection  within  two  days. 

Morphine  relieves  cough  and  favors  expectoration.  The  latter 
is  apparent,  and  is  due  to  the  fact  that  the  cough  being  quelled  the 
sputa  collects,  so  that  when  raised  there  is  more  of  it.  Codeine  re- 
lieves cough  better  than  morphine,  and  does  not  interfere  with 
digestion  as  much.  Nor  is  it  so  apt  to  induce  a  habit,  though  not 
altogether  faultless  in  this  respect.  But  small  doses  of  emetine, 
lobelin  or  apomorphine  loosen  a  cough  by  increasing  the  fluidity  of 
the  mucus,  and  soothe  the  irritated  mucous  membrane.  The  inhala- 
tion of  steam  does  more  than  opiates  to  soothe  this  irritation. 
Strictly  irritative  cough  is  better  relieved  by  small  doses  of  chloro- 
form internally,  or  by  zinc  cyanide,  neither  of  which  is  objectionable 
in  the  way  morphine  is. 

Morphine  is  the  remedy  for  emergencies,  to  relieve  by  hypo- 
dermic when  there  is  great  pain  and  other  remedies  are  not  at  hand. 
Apart  from  this  the  field  for  the  legitimate  use  of  morphine  is  ex- 


284  MUSCARINE 

ceedingly  restricted.  In  diabetes  it  certainly  checks  the  output  of 
sugar,  but  we  have  been  unable  to  find  any  case  cured  by  it. 

The  treatment  of  acute  opiate  poisoning  consists  in  emptying 
the  stomach  promptly,  and  sustaining  the  respiration.  Hypodermics 
of  strychnine  are  useful,  with  artificial  respiration.  As  long  as  this 
is  sufficient  it  is  worse  than  useless  to  try  to  prevent  sleep.  Large 
doses  of  coffee  combat  the  effects  of  the  drug  to  some  extent,  but 
atropine  enhances  some  morphine  effects  while  combating  others. 
The  inhalation  of  oxygen  is  a  useful  measure. 

The  treatment  of  the  morphine  habit  is  a  very  simple  measure. 
The  patient  must  be  under  such  conditions  that  the  physician  can 
positively  control  the  quantity  of  the  drug  taken  ?  Unless  the  pa- 
tient is  willing  to  allow  this  he  is  not  really  desirous  of  quitting  his 
habit.  The  bowels  will  invariably  be  found  to  be  loaded  with  a 
quantity  of  feces  almost  past  belief.  This  accumulation  is  to  be  re- 
moved by  non-irritant  cathartics  and  enemas,  and  the  emunctories 
flushed  thoroughly.  The  strength  is  to  be  sedulously  maintained  by 
easily  digested  and  nutritious  food,  and  by  such  heart  tonics  as  may 
be  required — they  always  are.  When  released  from  the  paralyzing 
effects  of  the  drug  the  cells  pour  out  their  burdens  of  retained 
toxins  and  these  must  be  carried  out  of  the  body  promptly  and  con- 
stantly. Autotoxemia  is  the  cause  of  the  distress  known  as  "with- 
drawal symptoms."  The  morphine  is  best  taken  away  at  once, 
though  this  depends  on  the  case,  and  with  aged  subjects  who  have 
used  the  drug  long,  mercy  should  rule.  Severe  distress  calls  for  a 
moderate  dose  of  morphine,  and  revision  of  the  means  for  elimina- 
tion. After  48  hours'  abstinence  sleep  usually  comes  without  drugs. 
Hot  baths  are  of  great  service  and  very  grateful  to  the  patient. 

The  administration  of  other  stupefying  drugs  to  replace  mor- 
phine is  useless  and  apt  to  result  in  a  new  habit,  besides  smoothing 
the  way  to  a  return  to  the  opiate. 

MUSCARINE. 

Standard  granule — Sulphate,  gr.  1-250 — gm.  .00025. 

Muscarine  is  an  alkaloid  derived  from  the  Amanita  muscarius, 
or  fly  fungus.  It  is  of  syrupy  consistence,  soluble  in  water.  In  its 
action  it  closely  simulates  pilocarpine  and  picrotoxin,  but  is  more 
toxic.  Overdoses  occasion  marked  debility ;  the  pulse  becomes  weak 
and  small,  the  skin  pale  and  cold,  cold  sweat  appears,  followed  by 
vomiting  without  nausea  and  serous  purging  without  pain  or  dis- 


NARCEINE  285 

tress.  The  muscular  weakness  is  extreme.  These  symptoms  come 
in  one  or  two  hours  after  eating  the  mushrooms,  and  in  non-fatal 
cases  subside  within  two  hours,  leaving  a  sense  of  debility.  There  is 
no  cerebral  symptom  apart  from  some  vertigo  due  to  the  anemia  of 
the  brain.  Shoemaker  says  the  heart  and  lungs  are  slowed,  the 
heart  finally  stopping  in  diastole.  Blood  pressure  is  lessened 
markedly.  The  secretions  of  the  skin,  liver  and  intestines  are  in- 
creased, the  urine  reduced  or  suppressed.  Convulsions  may  occur 
from  carbonic  acid  accumulation.  The  pupil  is  contracted  by  the 
internal  use  of  muscarine,  dilated  by  its  local  application.  Cushny 
says  muscarine  causes  gastric  distress  much  more  marked  than  that 
of  pilocarpine  and  is  not  as  well  suited  for  remedial  uses.  But  the 
writer  noted  the  contrary  when  poisoned  by  this  agent. 

Shoemaker  gives  the  dose  of  muscarine  as  gr.  ^  to  ij,  but  this 
cannot  refer  to  the  muscarine  supplied  by  Merck.  It  is  a  difficult 
remedy  to  use,  because  it  is  so  rapidly  eliminated. 

The  best  way  to  use  this  powerful  agent  is  probably  to  ad- 
minister a  granule  in  solution  every  five  minutes  till  the  desired 
effects  are  manifest. 

The  active  agents  in  the  fungi  have  not  been  sufficiently  studied. 
One  is  employed  in  Russia  as  an  intoxicant,  of  such  attractiveness 
that  it  is  said  that  when  a  wealthy  man  goes  on  a  debauch  with  it, 
his  poorer  neighbors  drink  his  urine  to  obtain  a  second-hand  one 
thereby.  No  intoxication  or  pleasurable  effect  followed  when  the 
writer  partook  of  a  toxic  dose  of  the  fly  amanita ;  but  on  the  other 
hand  no  such  disturbance  of  the  stomach  occurred  as  Cushny  de- 
scribes. In  fact,  it  was  our  opinion  that  as  an  emetic  without  nausea 
and  a  cathartic  without  distress,  it  had  no  rival  in  the  known  materia 
medica. 

NARCEINE. 

Standard   granule — Gr.    1-67,   gm.   .001. 

Narceine  is  an  alkaloid  from  opium.  It  is  found  in  an  average 
proportion  of  0.2  per  cent.  Many  years  ago  Da  Costa  published  an 
account  of  some  trials  of  narceine  in  the  Reports  of  the  Pennsylvania 
Hospital;  in  which  he  concluded  that  this  agent  had  little  if  any 
value.  But  the  narceine  then  furnished  was  probably  too  impure  to 
warrant  any  deductions  whatever  from  its  trial.  The  same  may  be 
said  of  the  specimens  from  which  Claude  Bernard  derived  his  very 
favorable  opinion  of  this  alkaloid.  We  must  have  recourse  to 


286  NARCEINE 

modern  observations  made  with  agents  of  undoubted  purity  before 
advocating  or  condemning  a  drug. 

Narceine  is  soluble  in  945  parts  of  alcohol  at  80  per  cent,  easily 
in  boiling  alcohol,  not  at  all  in  ether,  benzole  or  petroleum  ether, 
slightly  in  chloroform  and  in  amylic  alcohol.  It  has  little  affinity  for 
acids,  but  forms  crystallizable  salts  with  hydrochloric,  sulphuric  and 
nitric  acids. 

Physiologic  Action. — Van  Renterghem  experimented  with  pure 
narceine.  He  took  evening  doses  of  gr.  il/2,  followed  by  slumber 
calm  and  more  profound  than  usual ;  waking  with  -a  sense  of  heavi- 
ness in  the  root  of  the  nose  and  the  forehead,  remaining  till  after- 
noon; the  narceine  did  not  interfere  with  the  customary  morning 
dose  of  saline  laxative,  but  the  stools  were  less  liquid.  The  appetite 
was  unaffected,  no  dryness  of  the  mouth  or  coating  of  the  tongue. 
One  day,  suffering  with  slight  diarrhea  with  abdominal  pains,  an 
evening  dose  of  narceine,  gr.  1^2,  was  followed  by  sleep  and  calmed 
the  intestinal  disorder.  Next  day  no  abnormal  sensations,  the 
bowels  acting  as  usual.  A  young  woman  of  20,  suffered  with  a 
cough  "ferine,"  and  he  gave  narceine  and  iodoform,  a  granule  each, 
every  quarter-hour.  Next  day  the  cough  had  ceased ;  she  had  begun 
on  the  third  tube  of  each — 20  granules  in  each — and  now  took  them 
every  hour. 

To  a  woman  of  26  affected  with  uterine  epithelioma  and  suffer- 
ing the  atrocious  pains  that  prevented  sleep,  resisting  galenic  opiates, 
Rabuteau  gave  a  vaginal  injection  containing  narceine.  One  hour 
later  the  pain  had  disappeared,  the  patient  was  soundly  asleep,  and 
on  his  next  visit  thanked  the  doctor  warmly.  This  happy  result 
was  repeated. 

He  also  obtained  satisfactory  results  from  narceine  in  sciatica, 
neuralgic  pains  of  various  sorts,  relieving  and  even  curing  them 
with  narceine,  which  often  proved  superior  to  morphine.  As  a 
remedy  for  cough  this  remedy  succeeded  for  Laborde  in  whooping- 
cough,  Line  in  acute  bronchitis,  Oettinger  and  Levis  in  asthma. 

As  a  muscular  relaxant  it  has  succeeded  in  hysteric  convulsions 
and  spasmodic  contracture  of  the  limb  that  had  resisted  morphine 
(Eulenburg). 

Rabuteau  says :  "This  precious  substance  also  arrests  diarrhea. 
Not  only  does  the  intestinal  mucosa  secrete  less  under  its  influence, 
but  the  buccal,  pituitary  and  even  the  conjunctival  mucosa  show  a 
sort  of  desiccation ;  thirst  augments  as  with  morphine.  Often  doses 
of  gr.  \y2  to  3  are  required  to  obtain  these  results,  and  diarrhea  is 


NARCEINE  287 

not  as  well  arrested  as  by  morphine.  Narceine  is  nevertheless  to  be 
preferred  as  not  causing  nausea  or  anorexia,  especially  with 
phthisical  cases  narceine  even  relieves  these  disagreements." 

Exceptionally  writers  have  mentioned  as  due  to  narceine,  vertigo, 
ringing  of  the  ears,  headache,  nausea  and  vomiting  on  waking,  or 
excitement  and  insomnia. 

Hypnotic  doses  after  a  period  of  acceleration  of  the  pulse,  slow 
the  heart  and  the  respirations;  if  the  narcotic  stage  is  prolonged 
there  may  even  be  a  lowering  of  the  temperature  (Eulenberg,  Sich- 
tung). 

The  pupils  do  not  contract  during  the  sleep  of  narceine,  and  the 
reflex  excitability  is  less  dulled  than  after  morphine   (Sichtung). 
Fabini  and  Ottolengui  state  that  narceine  increases  the  excre- 
tion of  urea.    Prolonged  use  induces  tolerance. 

Laborde  finds  narceine  perfectly  tolerated  by  infants. 
Injected  under  the  skin  it  diminishes  tactile  sensibility  as  mor- 
phine does ;  introduced  into  the  eye  it  does  not  affect  the  pupil 
(Eulenberg). 

Narceine  is  eliminated  chiefly  through  the  urine  and  the  bile 
(Dragendorff  and  Schmemann). 

Therapeutics. — Van  Renterghem  recommends  narceine  as  a  suc- 
cedaneum  for  morphine  in  treating  women  and  children,  weakly 
persons  and  those  unduly  susceptible  to  opiates.  Narceine  is  useful 
when  it  is  important  to  avoid  the  constipation  of  morphine.  As  a 
hypnotic  narceine  does  better  for  persons  bedfast,  gravely  ill,  than 
for  the  well ;  it  is  specially  valuable  in  insomnia  caused  by  obstinate 
cough,  as  in  phthisis.  Valledor  values  it  above  codeine  as  a  remedy 
for  coughs. 

Burggraeve  also  advised  narceine  for  harsh  coughs,  painful,  and 
as  a  calmant  of  the  nervous  system.  It  is  an  anodyne  analgesic  in 
the  pains  of  the  inflammations,  given  in  suitable  doses  even  during 
the  height  of  the  fever,  associated  with  the  other  modifiers  demanded 
by  the  case.  It  is  then  rare  that  this  remedy  does  not  lessen  the 
pain,  spasm,  agitation  and  fever.  Jn  neuralgias,  headache,  inter- 
costal neuralgia,  gastralgia,  sciatica,  narceine  often  succeeds  when 
morphine  fails.  Here  aconitine,  gelseminine,  butyl-chloral,  atropine 
or  cicutine  should  be  associated  as  indicated. 

The  granules  of  gr.  1-134  each,  Van  Renterghem  gives  to  a  new- 
born infant  without  division,  if  needed,  every  hour.  Older  children 
can  take  two  to  five  granules  at  each  dose.  It  may  be  given  hypo- 
dermically.  Harley's  formula  is  preferred :  Pure  narceine  3  parts, 


288  NARCOTINE 

glycerin  45 ;  warm  slightly  to  perfect  solution,  then  add  I  part 
hydrochloric  acid  and  2,  parts  distilled  water.  This  makes  a  solution 
of  one  part  to  twenty — or  5  per  cent. 

Narceine  has  received  little  attention  at  the  hands  of  American 
alkalometrists,  because  the  tendency  here  is  to  make  little  use  of 
opiates,  and  when  unavoidable  to  substitute  codeine  for  morphine. 
But  the  foregoing  account  of  the  French  investigations  show  that 
there  are  values  in  narceine  that  should  not  be  overlooked. 


NARCOTINE. 

Narcotine  forms  about  6  per  cent  of  opium,  the  percentage  vary- 
ing widely. 

The  formula  is  C22H23NO7.  It  resembles  codeine  somewhat 
more  closely  than  it  does  morphine,,  but  has  less  depressant  action 
than  either.  In  frogs  it  causes  some  depression,  quickly  followed  by 
an  increase  of  reflex  excitability  like  that  produced  by  strychnine. 
In  mammals  the  depression  is  still  slighter,  followed  by  excitement, 
restlessness,  tremors,  increase  of  reflex  excitability  even  to  con- 
vulsions, ending  in  death ;  the  symptoms  exactly  coinciding  with 
those  of  strychnine.  The  pulse  is  slowed  by  direct  action  on  the 
heart.  Very  large  doses  have  been  taken  with  little  or  no  narcotic 
effect,  narcotine  being  much  less  toxic  than  codeine  (Cushny). 

Narcotine  is  considered  a  cotarnine  opianate.  Narcotine  is  ob- 
tained by  exhausting  opium  with  water,  treating  with  hydrochloric 
acid,  precipitating  with  sodium  carbonate,  and  crystallizing  in  alco- 
hol in  the  presence  of  a  little  animal  black.  It  forms  handsome  nee- 
dle crystals,  insoluble  in  water,  soluble  in  hot  alcohol,  in  choroform, 
and  in  33  parts  of  ether  (Bocquillon). 

Narcotine  possesses  antiperiodic  properties  similar  to  those  of 
quinine,  which  it  is  said  to  excel.  It  causes  diaphoresis.  It  is  the 
least  toxic  of  the  opium  alkaloids  (Claude  Bernard),  less  convulsanf 
than  thebaine  and  papaverine,  while  doses  of  0.40  (gr.  6)  did  not 
induce  somnolence. 

This  agent  has  been  used  in  malarial  affections  in  India,  in  doses 
of  0.05 — 0.15  (Shaughnessy),  and  narcotine  sulphate  in  doses  of 
one  gram  (Root). 

When  narcotine  is  oxidized,  oxygen  and  water  are  abstracted 
and  the  base  is  decomposed  into  opianic  acid  and  cotarnine.  The 
hydrochlorate  of  cotarnine  has  been  termed  stypticin,  from  its  styptic 
properties.  The  formula  is  C,H4NO4C1  (Merck  gives  it  as 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


NARCOTINE  289 

C12H13NO3HO  HC1).  It  is  a  yellow  crystalline  powder,  very  bitter, 
easily  soluble  in  water  and  in  warm  alcohol.  The  solutions  are  yel- 
low but  become  darker  on  exposure  to  light.  Its  chemical  constitu- 
tion closely  approximates  that  of  hydrastinine,  differing  by  the  sub- 
stitution of  the  methoxyl  group,  OCH3  for  an  atom  of  hydrogen. 
The  physiologic  effects  confirm  this  close  relationship.  In  frogs 
stypticin  causes  central  paralysis.  In  mammals  large  doses  cause 
narcotism,  followed  by  paralysis,  death  occurring  from  paralysis 
of  the  respiratory  center.  The  fatal  result  can  be  prevented  by 
artificial  respiration.  No  influence  on  the  circulation  could  be  de- 
tected, wherein  it  differs  from  hydrastinine.  Nevertheless,  clinical 
observation  has  demonstrated  that  stypticin  possesses  valuable 
hemostatic  properties.  This  is  especially  the  case  with  uterine 
hemorrhages.  It  is  useless  in  hemorrhage  from  uterine  cancer.  So 
also,  it  has  proved  ineffective  in  hemorrhages  depending  upon  pelvic 
exudations  and  ovarian  congestions.  In  menorrhagia  and  metror- 
rhagia  it  has  proved  exceedingly  effective.  The  drug  is  well 
tolerated  by  the  stomach.  Pregnancy  does  not  contraindicate  its 
use  (Liebreich),  as  it  does  not  cause  uterine  contractions. 

Rousse  and  Walton  pronounced  stypticin  a  tonic  to  the  circula- 
tion, especially  the  heart,  and  useful  in  hemoptysis.  The  dose  is 
0.20  (gr.  3),  best  hypodermically  in  the  gluteal  region  (Gotts- 
chalk).  In  very  severe  menorrhagias  he  gave  it  four  hours  before 
the  expected  flow.  By  the  mouth,  0.025  (gr.  l/2}  five  times  a  day,  in 
capsule  or  tablet ;  the  latter  being  preferable  on  account  of  the  bit- 
terness. Hypodermically  it  may  be  injected  in  10  per  cent  watery 
solution  (Merck). 

Especially  in  the  profuse  menstruation  of  young  girls  it  has 
proved  effective  and  in  those  occurring  about  the  climacteric.  Merck 
recommends  it  in  doses  from  gr.  y±  to  4,  five  times  a  day. 

Gottschalk  gives  stypticin  the  preference  over  other  hemostatics 
in  dysmenorrheic  hemorrhages,  on  account  of  its  sedative,  anodyne 
and  soporific  properties.  In  subinvolution  the  hemostatic  effects 
were  in  every  case  permanent,  which  would  indicate  the  valuable 
power  of  contracting  the  connective  fibers,  but  not  the  muscular 
tissue  of  the  enlarged  uterus.  The  action  is  primarily  on  the  nervous 
centers,  lowering  the  rapidity  of  the  respiration  and  secondarily  the 
blood-pressure.  It  is  therefore  a  relaxant  hemostatic,  for  active 
hemorrhages. 

Boldt  has  found  stypticin  useful  in  acne,  rosacea,  eczema, 
urticaria,  etc.,  when  connected  with  menstruation.  Munk  found  it 


290  NICKEL   BROMIDE 

effective  in  restraining  hemorrhages  following  the  extraction  of 
a  tooth,  inserting  a  tablet  in  the  cavity.  He  suggests  the  same  local 
application  for  the  bleeding  following  circumcision.  It  is  not,  how- 
ever, a  local  blood-coagulant,  but  a  true  hemostatic,  acting  by  vaso- 
constriction  of  the  small  vessels. 

Bloch  recommends  stypticin  topically  for  parenchymatous  bleed- 
ing from  cavities. 

Marcus  found  its  internal  use  ineffective  in  checking  bleeding 
occurring  in  dental  cases,  but  the  direct  application  never  failed, 
besides  being  painless1.  Hulisch  testifies  to  the  efficacy  of  stypticin 
applied  locally,  in  dental  work  upon  notorious  hemophiliacs.  Munk 
found  10  per  cent  solutions  strikingly  successful  in  checking 
epistaxis,  and  Jahl  succeeded  in  the  same  cases  by  applying  stypticin 
gauze. 

Among  the  authorities  who  have  reported  favorably  on  the 
hemostatic  property  of  stypticin  are  Boldt,  McGee,  Gottschalk, 
Nassauer,  Gaertig,  Bakofen,  von  Braitenberg,  Bossi,  Freund,  Nedo- 
rodow,  Pazzi,  Paoletti,  Zaramella,  Heyden,  Abegg,  Walther, 
Lavialle,  Ruyssen,  Munk,  Bloch,  Jahl,  Marcus  and  Hulisch. 

NICKEL   BROMIDE. 

Standard  granule — Gr.   1-6,  gm.  .01. 

Nickel  bromide  is  a  deliquescent  salt,  of  greenish  color.  It  was 
introduced  to  afford  the  benefits  of  the  bromides  in  a  small  dose. 
In  effect  gr.  \y2  equals  half  a  dram  of  potassium  bromide. 

Da  Costa  employed  nickel  bromide  in  epilepsy  with  success. 
Hare  recommends  it  in  melancholy  and  hysteria. 

In  large  doses  Cushny  ranks  nickel  with  cobalt  as  a  poison. 

Like  the  other  bromides  this  sedates  the  functions  of  the  brain, 
dulls  the  sensibility  of  the  faucial  mucosa,  and  allays  irritability  of 
the  sensory  nerves.  It  sedates  the  sexual  function  without  destroy- 
ing desire,  rendering  erection  impossible.  A  like  influence  is  exerted 
on  the  ovaries.  The  reflexes  are  sedated,  motor  power  diminished, 
and  the  vascular  tension  relaxed.  The  heart  is  slowed  and  weakened, 
but  not  as  much  as  by  potassium  bromide.  Very  large  doses  slow 
the  respiration  and  lower  the  temperature.  Cerebral  anemia  is 
produced,  according  to  Hammond.  As  a  mild  and  harmless  seda- 
tive the  bromide  of  potassium  has  been  employed  to  an  enormous  ex- 
tent of  late ;  and  yet  beyond  a  limited  field  there  is  no  evidence  of  its 
usefulness.  Tons  of  this  drug  have  been  administered  as  placeboes, 


NICKEL   BROMIDE  291 

or  with  very  little  idea  as  to  its  effects  beyond  a  temporary  masking 
of  symptoms  by  lowering  sensibility. 

Therapeutics. — Cerebral  fullness  and  irritability  in  children  are 
relieved  by  a  few  small  doses  of  bromide ;  but  as  these  usually  come 
from  some  irritating  substances  in  the  alimentary  canal,  the  old  prac- 
tice of  administering  a  dose  of  ipecac  or  of  castor  oil,  though  less 
pleasant,  was  indubitably  more  efficacious  and  rational. 

In  the  grave  cerebral  and  meningeal  inflammations  we  have 
never  witnessed  any  benefit  from  the  enormous  doses  of  bromide 
usually  given.  Purging  and  vascular  sedatives  are  immeasurably 
more  effective;  followed  by  absorbents.  In  exophthalmic  goiter 
veratrine  is  better ;  with  cicutine  hydrobromate.  When  goiter  coin- 
cides with  irritation  of  the  genital  apparatus  the  bromides  will  give 
temporary  relief.  But  there  are  few  more  objectionable  practices  in 
modern  medicine  than  the  drugging  down  the  sensibility  by 
bromides.  Much  better  find  the  causes  of  irritation  and  remove 
them.  And  it  cannot  be  without  harm  that  a  drug  which  so  mark- 
edly depresses  the  sexual  power,  that  index  of  the  vital  force,  is 
given  so  freely  and  continuously  as  this.  The  practice  of  medicine 
teaches  the  lesson  of  using  every  possible  means  of  increasing  and 
cultivating  the  vital  forces ;  and  the  use  of  depressants  beyond  tem- 
porarily, is  a  bad  tendency. 

In  epilepsy  the  bromides  have  long  been  relied  upon  by  the  pro- 
fession to  such  an  extent  that  the  routine  consists  in  giving  enough 
to  ward  off  the  paroxysms,  and  neglect  every  means  of  ascertaining 
and  removing  the  causes  of  the  malady.  Sometimes  it  requires  huge 
doses  to  do  this — the  writer  has  given  an  ounce  of  potassium 
bromide  a  day  for  17  months  to  an  epileptic.  But  it  is  better  to  give 
nickel  bromide  up  to  10  grains  a  day,  then  if  the  fits  continue  add 
arsenic  bromide  to  strengthen  the  bromide  effect  and  prevent  acne, 
and  the  other  small-dose  bromides,  of  gold,  mercury,  cicutine,  etc., 
till  the  fits  cease.  Meanwhile  the  sources  of  morbid  irritability  are 
to  be  found  and  removed.  This  offers  a  better  prospect  of  cure  than 
the  senseless  drugging  with  bromides  in  vogue. 

When  it  is  desirable  to  reduce  the  sexual  ardor,  the  bromides 
may  be  given  freely ;  though  gelseminine,  salicin,  and  the  sulphides, 
accomplish  this  object  at  least  as  well. 

The  authors  do  not  approve  of  long  continued  bromidizing,  and 
hence  there  is  no  danger  in  using  nickel.  The  dose  of  nickel  bromide 
for  an  adult  is  one  to  five  grains,  and  up  to  15  grains  a  day. 


292  NUCLEIN 

NTJCLEIN. 

Standard  tablets — Gtt.  1-2,  and  gtt.  2.    Nuclein  Solution. 

Nuclein  can  be  and  often  is  obtained  from  the  egg,  the  spleen, 
the  thyroid  gland  and  other  portions  of  the  animal  economy,  but  as 
a  matter  of  uniformity  and  to  avoid  danger  from  decomposition  it 
has  been  found  better  to  procure  it  from  live  cereal  germs,  involv- 
ing, however,  chemical  processes  requiring  much  time  and  labor. 

Physiologic  Action. — When  administered  hypodermically,  nuclein 
promptly  produces  a  rapid  increase  in  the  number  of  leucocytes ; 
this  increase  varies  somewhat  with  the  subject  and  the  disease  from 
which  he  suffers,  but  in  all  cases  there  is  a  most  decided  augmenta- 
tion. The  polynuclear  cells  are  particularly  affected.  These  cells, 
as  has  been  shown  by  Metchnikoff,  are  the  most  active  of  the 
phagocytes.  That  the  bactericidal  power  of  the  blood  serum  when 
free  from  corpuscular  elements  is  due  to  nuclein  is  unquestioned ; 
this  nuclein  is  found  free  in  the  blood  and  is  supposed  to  be  secreted 
by  the  leucocytes.  The  administration  of  nuclein  has  been  shown  to 
increase  this  bactericidal  power  of  the  blood  many  fold.  The  effect 
of  a  dose  passes  away  in  from  thirty  to  forty-eight  hours,  hence  the 
necessity  of  continuous  administration.  Care,  however,  should  be 
exercised  not  to  overwork  and  therefore  exhaust  the  cells.  In  some 
cases  the  exhibition  of  large  doses  at  longer  intervals  is  better  than 
the  continuous  use  of  smaller  quantities. 

Briefly,  the  whole  practical  basis  of  nuclein  therapy  is  the  in- 
crease of  leucocytosis :  By  its  administration  we  obtain  an  increase 
in  the  phagocytic  action  and  furthermore  add  to  the  number  of 
these  natural  defenders  of  the  body's  health.  When  the  system  be-  ' 
comes  so  depleted  by  disease  and  the  presence  of  morbid  germs  that 
cell  repair  is  hindered  or  stopped  altogether,  we  are  face  to  face  with 
a  condition  that  has  baffled  science  throughout  the  history  of  intel- 
ligent medication.  Now  the  discovery  of  nuclein  enables  us  to  so 
stimulate  cell-formation  and  phagocytosis  that  the  materies  morbi 
is  surrounded,  consumed  and  thrown  out  of  the  body  as  waste 
while  at  the  same  time  the  normal  restoration  goes  on. 

Therapeutics. — In  all  cases  of  infection  of  the  system  as  well  as 
in  all  anemic  and  chlorotic  conditions  nuclein  will  prove  invaluable. 
If  given  per  os  it  is  well  to  give  it  on  an  empty  stomach  and  to  give 
no  water  following  so  as  to  secure  quick  absorption  from  the  buccal 
mucous  membrane  and  stomach.  In  phthisis  its  administration  is 
followed  by  a  prompt  fall  in  the  temperature  and  a  general  ameliora- 
tion of  all  symptoms.  Indolent  ulcers  take  on  a  new  aspect  and  as 


NUCLEIN  293 

granulation  progresses  normally  and  rapidly,  are  soon  healed.  In 
typhoid,  and  other  diseases  where  marked  deficiency  of  leucocytic 
action  is  evident  it  is  an  invaluable  adjunct  to  all  treatments,  and 
the  worst  of  these  will  produce  better  results  with  nuclein  than  the 
best  without  it.  In  malarial  dyscrasias,  in  intestinal  and  gastric  dif- 
ficulties and  in  fact  in  all  forms  of  disturbed  metabolism  (and 
therefore  faulty  cell  repair)  this  agent  should  be  used  freely.  The 
list  if  carried  out  would  thus  embrace  all  conditions  of  lowered 
vitality,  the  acute  infections,  such  as  diphtheria,  tonsillitis,  typhus 
and  all  the  exanthemata,  most  disorders  of  the  liver  and  nearly  all 
the  diseases  of  the  skin. 

When  administered  in  doses  of  from  two  to  ten  drops  of  the 
medicinal  solution  it  soon  causes  a  feeling  of  stimulation  and  well- 
being  and  many  a  time  improvement  has  been  manifest  from  the 
very  first  dose. 

In  the  following  list  of  diseases  to  which  nuclein  is  applicable, 
we  present  a  few  hints  that  we  trust  will  be  helpful  and  incite  to 
fresh  study. 

Anemia.  Here  the  dose  of  nuclein  must  be  reasonably  small.  It 
has  been  demonstrated  that  if  administered  in  five  to  ten  drop  doses, 
two  or  even  three  times  a  day,  there  is  a  rapid  increase  in  the  red 
blood  corpuscles,  but  if  larger  doses  are  taken  and  oftener  and  con- 
tinued for  some  time,  then  there  is  almost  as  rapid  decrease. 
Anemics  are  as  a  rule  always  constipated. 

Arthritis  calls  for  nuclein,  more  especially  in  those  patients  who 
have  through  prolonged  uric-acid  poisoning  become  anemic. 
Salicylic  acid  may  be  used  locally  with  advantage  and  the  emunc- 
tories  should  be  kept  open. 

Asthma  cannot  be  per  se  controlled  by  nuclein,  but  its  exhibition 
gives  the  patient  a  better  systemic  condition  and  thus  enables  him 
to  throw  off  the  disease  more  easily  under  appropriate  treatment. 
This  consists  to  a  great  extent  of  elimination  and  cerebro-spinal 
tonics.  The  attacks  are  controlled  usually  with  glonoin,  or  apo- 
morphine,  strychnine,  hyoscyamine  and  glonoin  one  granule  of  each 
dissolved  in  a  little  hot  water  and  given  every  ten  or  fifteen  minutes. 
Iodized  calcium  should  also  not  be  forgotten ;  in  fact,  it  is  clearly 
indicated  in  most  cases. 

Bronchitis  in  all  its  forms  responds  quickly  to  nuclein  medica- 
tion. The  prompt  use  of  iodized  calcium  with  tonic  treatment  is 
suggested  as  abortive. 

Bronchopneumonia.     The  dose  of  nuclein  should  be  large,  ten 


294  NUCLEIN 

to  twenty  drops  given  hypodermically  every  four  or  six  hours. 
Strychnine  and  arterial  sedatives  in  the  early  stage.  When  there  is 
capillary  involvement  the  use  of  potass,  bichromate  is  followed 
by  prompt  improvement.  Emetine  and  brucine  are  the  drugs  that 
prove  most  efficacious  in  children's  cases. 

Cancer.  Nuclein  in  many  instances  has  brought  about  a  marked 
improvement  and  when  combined  with  condurangin  is  perhaps  one 
of  the  most  reliable  remedies  that  we  possess.  Full  dosage — prefer- 
ably hypodermically — for  a  prolonged  period,  and  in  the  periphery 
of  the  growth,  gives  best  results. 

Cholera  infantum  in  its  early  stages  is  controlled  beautifully  by 
small  doses  of  atropine,  copper  arsenite  and  nuclein.  The  latter  is 
best  given  here  in  solution  which  can  be  dropped  on  the  child's 
tongue. 

Chorea.  In  this  disease  the  most  beneficial  results  have  followed 
full  doses  of  nuclein  given  for  a  prolonged  period,  the  Triple 
Arsenates  with  Nuclein  .being  usually  a  good  form. 

Debility,  general  and  senile,  naturally  calls  for  nuclein,  but  it 
must  be  given  more  as  an  adjunct  to  strong  and  prolonged  tonic 
treatment;  the  use  of  nutritious,  easily-digested  and  sometimes  pre- 
digested  food  should,  if  nuclein,  strychnine  and  arsenic  are  ex- 
hibited, soon  cause  any  weakness  to  vanish. 

Diabetes  mellitus  has  been  influenced  most  favorably  by  nuclein. 
If  the  proper  diet  is  ordered  and  arsenic  and  gold  bromide  are  ex- 
hibited, together  with  hypodermic  injections  of  increasing  doses  of 
nuclein  every  day  there  is  no  question  but  that  a  fair  percentage  of 
cases  will  go  on  to  cure. 

Diarrhea,  when  it  assumes  a  chronic  type,  leaves  the  system  in 
just  that  condition  which  calls  most  imperatively  for  nuclein.  Its 
administration  should  be  begun  early  and  with  it  strychnine,  hydras- 
tine  and  the  Intestinal  Antiseptics  (W-A)  should  be  given.  Small 
doses  of  a  saline  laxative  are  often  called  for,  but  its  use  must  be 
determined  by  the  type  of  case.  The  acute  form  needs  small  doses 
of  calomel  followed  by  a  saline  and  after  the  bowel  is  thoroughly 
emptied,  the  intestinal  antisepsis. 

Diphtheria.  In  this  dread  destroyer  of  the  little  ones  the  doctor 
who  does  not  use  nuclein  and  peroxide  of  hydrogen  and  calcium 
sulphide  is  open  to  defeat.  Here  as  in  other  diseases  it  is  important 
to  have  an  exaggerated  leucocytosis  present  and  as  already  pointed 
out  the  larger  the  dose  of  nuclein  the  more  rapidly  can  this  condi- 
tion be  produced.  The  solution  should  be  injected  promptly  in 


THERAPEUTIC   NOTES 


THERAPEUTIC    NOTES 


NUCLEIN  295 

fifteen  or  even  thirty-drop  doses  repeating  every  six  or  eight  hours 
for  the  first  two  or  three  days ;  after  that  it  is  safe  to  continue  the 
medication  per  os.  Peroxide  of  hydrogen  must  be  used  freely  and 
usually  pure,  the  fauces  and  nasal  passages  being  flushed  with  it 
constantly.  Calcium  sulphide  should  be  given  to  saturation,  and 
iodized  calcium  should  be  exhibited  in  five-grain  doses  t.  i.  d.  The 
heart  needs  sustaining  with  strychnine  and  cactin,  the  former  being 
replaced  in  the  case  of  very  young  children  by  brucine.  Elimination 
must  be  kept  up. 

Dysmenorrhea  cannot  naturally  be  influenced  directly  by  this 
remedy,  but  the  patient  will  be  benefited  generally  and  the  doctor 
will  have  better  material  to  work  upon  if  nuclein  and  the  tonic 
arsenates  are  exhibited.  Here,  too,  watch  and  see  that  elimination 
is  kept  up. 

Eczema  and  nearly  all  skin  disorders  are  the  outward  manifesta- 
tion of  a  general  bodily  dyscrasia  and  nuclein  will  prove  of  great 
benefit.  There  are  but  few  forms  of  skin  disease — if  indeed  there  be 
any — which  will  not  yield  sooner  or  later  to  thorough  and  continu- 
ous elimination,  blood  building  and  an  aseptic  bowel. 

Exanthemata.  In  all  the  eruptive  diseases  the  administration  of 
nuclein  is  of  great  benefit.  It  makes  no  difference  how  the  case  is 
treated  otherwise,  the  addition  of  nuclein  per  os  or  hypodermically 
will  prove  of  benefit.  The  one  point  that  needs  attention  is  the 
dosage.  The  small  dose,  per  os,  in  the  early  stages  once  or  twice 
daily,  and  in  latter  stages  of  a  severe  or  badly-treated  case  full  doses 
hypodermically  give  best  results.  Calcium  sulphide,  tonics  and  al- 
ways elimination  are  also  indicated. 

Exophthalmos  is  another  disease  which  in  its  early  stages  yields 
with  marked  rapidity  to  nuclein  hypodermically.  In  these  cases 
there  is  always  a  defective  metabolism  together  with  more  or  less 
nervous  irritation.  Iodine  is,  unquestionably,  next  to  nuclein  the 
remedy  of  choice  and  the  best  form  in  which  to  exhibit  this  drug  is 
calcium  iodized.  Mercury  biniodide,  applied  externally  by  inunction 
and  taken  internally  in  minute  dosage,  has  warm  advocates  as  also 
has  phytolaccin. 

Fever.  The  best  treatment  is  to  administer  one  of  the  arterial 
sedatives,  aconitine,  gelseminine  or  veratrine,  in  small,  frequently- 
repeated  doses,  support  the  heart  with  digitalin  or  strychnine  and, 
at  the  same  time,  aid  elimination.  Given  in  moderate  dose  nuclein 
promotes  oxidation,  favors  the  elimination  of  waste  and  all  deleteri- 
ous products  and,  finally,  and  most  important  of  all,  stimulates  the 


296  NUCLEIN 

phagocytes  and  enables  these  soldiers  of  the  system  to  surround  and 
destroy  the  invader. 

Influenza  (la  grippe)  is  again  but  an  evidence  of  cell  disturbance 
and  retention  of  toxins.  Clinical  experience  has  demonstrated  that 
the  theory  that  here  nuclein  should  be  the  remedy,  is  correct.  After 
compelling  free  elimination  see  to  it  that  the  heart  is  supported  with 
strychnine,  etc.,  and  the  body  rendered  an  unfertile  and  uncongenial 
field  for  the  influenza  bacillus  by  saturating  the  patient  with  iodized 
calcium,  and  finally,  with  nuclein,  aid  in  the  restoration  of  normal 
cell  function. 

Pharyngitis  (Follicular)  is  readily  controlled  by  nuclein  through 
its  action  on  the  body  secretions,  but  with  it  should  be  given  calcium 
sulphide  to  saturation  (especially  in  the  beginning)  and  hourh 
doses  of  potassium  bichromate,  gr.  1-67. 

Phthisis.  It  would  be  really  repetition  to  point  out  the  indica- 
tions for  the  use  of  nuclein  in  phthisis.  Be  the  general  treatment 
what  it  may,  there  is  only  one  remedy  which  can  possibly  restore 
cell-activity  and  that  is  nuclein.  The  dose  should  be  carefully 
gauged;  five  drops  every  day  will  do  at  first  but  this  should  be 
gradually  increased  as  necessity  may  arise.  The  best  effects  have 
been  obtained  from  daily  hypodermic  exhibitions. 

Rheumatism.  The  main  effort  should  be  to  get  rid  of  the  toxic 
matter  in  the  system  at  the  time  and  prevent,  by  improving  the  gen- 
eral tonus,  the  manufacture  of  more.  Calcalith,  colchicine  and 
salines  are  the  agents  par  excellence  with  which  to  "clean  out"  and, 
after  this  has  been  done,  then  nuclein  is  the  remedy  with  which  the 
patients'  condition  may  be  rendered  somewhat  more  nearly  normal. 

Tonsillitis  and  quinsy  have  been  cured  so  quickly  by  the  use  of 
nuclein  that  its  specific  character  in  these  diseases  is  generally  al- 
lowed. As  soon  as  the  first  symptoms  appear,  begin  to  administer 
small  doses  of  calomel  (say  1-6  grain  every  half -hour  for  eight 
doses),  follow  with  a  laxative  and  throughout  give  every  two  hours 
two  drops  of  nuclein  solution.  After  twenty-four  hours  the  acute 
condition  will  as  a  rule  subside,  then  the  nuclein  should  be  continued 
for  a  week,  three  times  a  day. 

Typhoid.  While  this  is  to  be  treated  generally  as  directed  under 
the  head  of  "Fevers,"  there  are  a  few  things  to  be  remembered 
which  apply  here  particularly.  When  nuclein  is  given  in  full  dosage, 
along  with  intestinal  antisepsis  and  free  elimination,  there  is  estab- 
lished, as  has  already  been  pointed  out,  an  artificial  leucocytosis, 


NUCLEIN  297 

with  the  result  that  in  a  few  hours  the  entire  character  of  the  dis- 
ease is  changed. 

Septicemia.  In  septicemia  nuclein  gives  the  most  brilliant  re- 
sults. Wherever  it  is  possible  to  get  at  and  remove  the  source  of  the 
trouble  the  administration  of  nuclein  with  calcium  sulphide  and 
elimination  enables  the  system  to  rally  and  dispose  of  the  poisons 
which  have  already  gained  access  to  the  circulation. 

Struma.  Strumous  and  rachitic  children,  generally  intractible 
cases,  will  improve  rapidly  on  nuclein  and  calcium  salts  with  skin 
friction,  exercise  and  proper  diet.  See  that  the  alimentary  canal  is 
emptied  and  that  the  digestive  processes  are  in  good  order. 

Syphilis.  In  syphilis,  nuclein  and  stillingin  should  be  given  to 
full  effect  together  with  mercury  protoiodide;  beginning  with  the 
latter  in  small  doses  and  gradually  increasing  the  dose  to  full  toler- 
ance. 

During  pregnancy  the  use  of  nuclein  is  strongly  indicated  and 
in  the  few  cases  where  it  has  been  used  the  results,  both  as  regards 
mother  and  child,  have  been  quite  remarkable. 

The  aged  benefit  very  much  by  full  doses  of  nuclein  given  three 
times  a  day  together  with  saline  laxatives  in  the  morning  and  two 
to  three  granules  of  the  Trinity  at  bedtime.  Nuclein  te  reconstruc- 
tive, fortifying  the  body  against  rapid  waste,  hence  the  above  indica- 
tion. 

In  children  of  a  dwarfish  habit,  or  those  who  seem  to  be  delicate 
without  apparent  cause,  we  are  almost  certain  to  find  defective  as- 
similation, both  primary  and  secondary.  Nuclein,  with  proper  elim- 
inative  remedies,  is  indicated. 

Administration. — Hypodermic  Injection.  In  giving  nuclein  hy- 
podermically  it  is  imperatively  necessary  that  not  only  shall  the 
syringe  and  needle  be  sterile  but  that  the  skin  itself  shall  be  sur- 
gically clean.  The  most  satisfactory  plan  to  follow  is  this.  Use 
only  a  solid  metal  or  glass  syringe.  The  whole  syringe  should  either 
be  soaked  in  alcohol  or  boiled  for  a  few  moments.  While  this  is 
being  done  the  skin  over  site  of  puncture  should  be  washed  with 
ethereal  soap  or  plain  soap  and  water  and  then  sponged  off  with 
alcohol  or  ether.  Now  with  a  five  per  cent  solution  of  carbolic  acid 
go  over  the  spot  again  and  finally  dry  with  sterile,  absorbent  cotton. 
Cover  the  area  with  a  wad  of  this  while  getting  ready  to  inject. 

Having  wiped  off  the  syringe  with  cotton  (sterile),  draw  up  the 
amount  of  nuclein  you  propose  to  inject  from  the  bottle  direct  and 


298  PAPAYOTIN 

if  for  constitutional  effect  add  at  least  an  equal  quantity  of  distilled 
water,  but  if  for  local — as  in  cancer,  etc. — inject  pure. 

See  that  the  fluid  is  well  up  to  the  point  of  needle  before  inject- 
ing and  after  ejecting  a  drop  wipe  off  the  needle  with  cotton  soaked 
in  alcohol  and  with  a  firm  hand  push  it  well  home  under  the  skin. 
Inject  the  nuclein  slowly,  withdraw  the  needle  and  seal  the  puncture 
with  a  touch  of  collodion. 

If  these  measures  are  taken  you  will  never  have  the  chill  or 
flushing  which  some  practicians  claim  follows  the  injection  of 
nuclein.  This  simply  means  that  some  septic  matter  was  injected 
with  the  nuclein  and  as  some  of  the  preparations  are  from  animal 
matter  it  is  easy  to  see  how  a  mild  septicemia  can  follow  the  use, 
without  aseptic  precautions,  of  such  a  nuclein  solution. 

Dose  of  Nuclein  By  Mouth.  There  is  something  in  the  manner 
of  exhibition.  When  a  rapid  and  marked  leucocytosis  is  desired  the 
dose  should  be  ten,  fifteen  or  twenty  drops  and  repeated  every  three 
or  four  hours.  If,  however,  the  general  tonic  and  sustaining  effect 
of  nuclein  is  desired  the  dose  should  be  small,  five  drops  being  the 
maximum — and  this  should  be  given  not  oftener  than  three  times  or 
better  twice  a  day.  One  thing  has  been  proved  by  experience  and 
this  is  that  nuclein  should  not  be  taken  within  an  hour  of  eating. 
The  best  time  is  when  the  stomach  is  most  nearly  empty,  as  absorp- 
tion is  more  rapid  and  complete  and  there  is  not  the  probability  of 
chemical  change  taking  place.  When  the  digestive  function  is  active 
there  is  an  undoubted  loss  of  effect. 

PAPAYOTIN. 

Standard  granules — Gr.  1-67,  gm.  .001 ;  gr.  1-6,  gin.  .01. 

From  the  pawpaw,  Carica  papaya,  is  derived  an  enzyme,  papayo- 
tin,  which  has  the  power  of  digesting  all  the  elements  of  a  meal,  fat, 
starches  and  albumin.  It  forms  peptone.  It  acts  at  any  tempera- 
ture, and  in  either  acid,  alkaline  or  neutral  conditions,  though  it 
acts  more  quickly  in  alkaline  solutions.  It  has  no  action  on  the 
body  when  taken  into  the  stomach,  simply  digesting  the  food  and 
nothing  more.  Its  powers  as  a  universal  digestant  of  all  forms  of 
food  render  it  widely  applicable.  It  has  been  proposed  to  utilize  it  to 
digest  intestinal  parasites,  but  this  seems  still  doubtful.  It  has  been 
injected  into  tumors,  where  it  forms  peptomes,  but  the  utility  of  the 
procedure  has  not  been  proved.  Solutions  will  dissolve  the  mem- 
brane of  croup  and  diphtheria,  but  the  malady  is  not  affected.  In- 


PEPSIN  299 

jected  into  the  blood  it  paralyzes  the  heart  and  nerve  centers,  and 
causes  intestinal  hemorrhages.  In  the  subcutaneous  tissues  it  causes 
great  pain  and  inflammation,  with  high  fever. 

Finkler  credits  papayotin  with  antiseptic  powers,  and  Shoe- 
maker says  it  can  be  given  with  salol  or  weak  solutions  of  corrosive 
sublimate.  Dr.  E.  A.  Wood  praised  it  as  an  application  in  ozena, 
tuberculosis  of  the  larynx  and  lungs,  etc.  It  has  been  urged  as  a 
galactagog,  and  to  dissolve  cerumen  from  the  ear.  Sittmann  reports 
its  value  in  diarrheas  due  to  indigestion,  and  acute  gastritis.  It  has 
proved  useful  in  dilatation  of  the  stomach. 

The  dose  of  papayotin  is  a  grain  before  or  with  the  beginning 
of  each  meal.  As  with  the  other  artificial  digestants,  the  benefit  is 
less  in  the  quantity  of  food  digested  by  it  than  in  the  starting  up  of 
the  digestive  process.  The  great  value  of  papayotin  lies  in  its 
power  to  aid  in  indigestions  of  all  forms,  whether  of  fats,  starches 
or  albuminoids.  Add  to  this  that  it  is  not  so  liable  to  decomposition 
as  the  animal  products  like  pepsin,  and  works  irrespective  of  its 
surroundings,  whether  acid  or  alkaline. 

PEPSIN. 

Standard  granule — Gr.  1-6,  gm.  .01. 

The  pepsin  of  the  shops  is  obtained  from  the  stomach  of  the  pig. 
It  acts  only  in  the  presence  of  hydrochloric  acid,  the  best  results 
being  obtained  from  solutions  containing  0.2  per  cent  of  acid.  It 
digests  only  proteids.  In  very  many  cases  where  pepsin  has  received 
credit  it  has  been  due  to  the  acid  alone.  There  is  often  a  deficiency 
of  acid  when  pepsin  is  secreted  in  abundance.  Cushny  therefore 
limits  the  use  of  pepsin  to  cases  where  proteids  are  not  digested 
even  when  enough  acid  is  present.  Pepsin  wines  are  believed  to  be 
inert,  but  it  requires  a  stronger  alcoholic  solution  to  destroy  its 
proteolytic  power.  The  presence  of  superfluous  peptones  in  the 
stomach  at  the  end  of  digestion  prevents  the  action  of  pepsin. 
Alkalies  are  incompatible  with  pepsin;  mercury,  lead,  zinc  and 
copper  prevent  the  action  of  pepsin  by  precipitating  it.  Tannic  and 
gallic  acids,  creosote  and  phosphorus  are  also  incompatible.  Strong 
alcoholic  fluids  also  interfere  with  its  action. 

In  addition  to  its  uses  in  indigestion  of  albumen,  pepsin  has  a 
certain  therapeutic  power  peculiar  to  itself.  It  has  long  been  known 
that  preparations  containing  it  are  effective  in  allaying  irritation  of 
the  stomach,  the  vomiting  of  pregnancy,  sea-sickness,  etc. 


300  PHYSOSTIGMINE 

The  average  dose  of  pepsin  for  an  adult  is  a  grain  at  the  end  of 
each  meal,  with  a  due  addition  of  hydrochloric  acid. 

PHYSOSTIGMINE. 

Standard  granules — Physostigmine  salicylate,  gr.  i-iooo,  gm.  .0000625; 
gr.  1-250,  gm.  .00025. 

Physostigmine  is  an  alkaloid  derived  from  the  Physostigma 
venenosum,  the  ordeal  bean  of  Calabar.  The  plant  contains  at  least 
two  other  alkaloids,  calabarine  which  resembles  strychnine,  and 
eseridine  which  acts  like  physostigmine  but  is  milder. 

Physiologic  Action. — Physostigmine  resembles  pilocarpine  in  ac- 
tion. It  depresses  the  nerve  centers,  and  kills  by  paralyzing  the 
respiratory  center.  Consciousness  is  intact  after  the  respiration  is 
gravely  affected  and  the  muscular  force  weakened.  Some  prelim- 
inary stimulation  is  probably  induced.  Muscular  twitching  occurs, 
and  the  irritability  and  power  of  the  muscles  are  increased  by 
moderate  doses.  The  respiration  is  at  first  faster,  then  becomes 
slow  and  weak.  Small  doses  slow  the  pulse  and  raise  vascular 
tension,  larger  ones  slow  the  heart  still  more  and  the  pressure  falls. 
The  action  on  the  heart  is  direct,  not  through  inhibition.  It 
produces  powerful  contractions  of  the  stomach  and  intestine,  and 
increases  all  the  secretions — tears,  saliva,  perspiration,  mucus  and 
pancreatic  juice.  It  causes  contractions  of  the  bladder,  ureter, 
uterus  and  bronchial  muscular  structures.  It  contracts  the  pupil 
but  accommodates  the  eye  for  near  vision. 

Harnack  holds  that  physostigmine  acts  on  the  secretory  gland 
cells  and  on  the  muscular  fibers;  but  others  believe  that  it  acts  on 
the  nerve-ends  in  these  structures. 

Physostigmine  is  eliminated  mainly  through  the  kidneys,  ap- 
pearing a  few  minutes  after  ingestion.  Traces  appear  in  the  saliva 
and  the  bile. 

Van  Renterghem  took  during  a  day  about  gr.  1-22  of  Merck's 
pure  crystallized  physostigmine.  He  experienced  a  peculiar  sensa- 
tion in  the  throat,  as  of  a  morsel  that  could  not  be  forced  down  ex- 
cept by  repeated  strong  efforts.  This  began  five  minutes  after  each 
dose  and  reached  its  maximum  of  intensity  in  half  an  hour,  disap- 
pearing within  three- fourths  of  an  hour.  As  this  effect  was  uniformly 
experienced  he  attributed  it  to  local  action.  No  other  effect  was 
noted  but  a  slight  diminution  of  the  appetite.  Next  day  he  took 
about  gr.  1-20,  in  divided  doses,  gr.  i-ioo  every  hour.  By  noon  he 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


PHYSOSTIGMINE  301 

felt  slight  vertigo;  with  little  appetite.  Little  by  little  the  malaise 
augmented;  in  the  stomach  a  sense  of  spasmodic  non-painful  move- 
ment ;  no  nausea ;  firm  stool  with  discharge  of  urine ;  more  vertigo, 
face  pale,  whole  body  cool  without  shivering,  nails  blue,  sweat  on 
forehead  and  over  face;  fatigue;  easier  half  lying  down.  At  12:30 
energetic  intestinal  peristalsis,  stool,  followed  by  three  vomitings, 
not  preceded  by  nausea.  No  bile  thrown  up.  Slight  desire  to  sleep ; 
no  more  vertigo  but  felt  cold ;  pulse  normal  at  76  to  82 ;  now  64 ; 
axillary  temperature  36.8  C.  No  ocular  symptom.  By  2 130  all  had 
subsided,  heat  returned,  temp.  37.1,  pulse  70.  At  3  p.  m.  resumed 
taking  physostigmine  gr.  1-300  hourly  till  10  p.  m.  Dined  at  5,  lit- 
tle appetite,  frequent  urination,  no  other  effect.  At  the  hour  of  re- 
tiring the  pulse  was  76,  temp.  37.4  C.  A  good  night. 

Therapeutics. — As  a  depressor  of  the  cerebrum  it  has  been  used  in 
epilepsy  but  under  its  use  the  paroxysms  increase  in  frequency  and 
violence.  In  chorea  the  same  result  has  been  recorded.  It  has 
failed  also  in  tetanus.  In  flatulence  it  is  one  of  the  most  efficient 
remedies  at  our  disposal,  and  has  never  failed  the  writer.  In  cases 
of  chronic  morphinism  when  the  cheek  shows  a  dusky  flush,  the 
capillaries  passively  dilated,  the  brain  probably  in  a  state  of  passive 
dilatation  of  its  capillaries,  physostigmine  in  doses  of  gr.  i-ioo 
hypodermically  gives  exactly  the  sensations  of  morphine,  and  the 
patient  is  unable  to  detect  the  difference.  This  has  rendered  this 
agent  useful  in  the  treatment  of  such  cases.  The  dose  must  not  be 
repeated  more  than  once  in  twelve  hours,  or  increased,  or  the  de- 
pressing effects  of  the  drug  become  manifest  and  it  does  harm. 

Physostigmine  has  been  utilized  by  ophthalmologists  to  contract 
the  pupil,  oppose  the  effects  of  atropine,  and  in  treating  glaucoma. 

Van  Renterghem  cites  many  cases  in  which  tetanus  was  cured  by 
physostigmine,  even  tetanus  neonatorum.  It  is  not  a  remedy  for 
strychnine  poisoning.  Animals  fed  with  both  die  sooner  than  when 
strychnine  alone  has  been  administered.  Subbotin  found  it  useful 
in  fecal  impaction,  and  with  belladonna  and  nux  it  has  become  a 
common  prescription  for  constipation.  Maschka  cured  a  case  of 
diarrhea  with  flatulence,  due  to  intestinal  catarrh,  by  the  use  of 
physostigmine. 

Poisoning  by  Calabar  bean  is  treated  by  evacuating  the  stomach, 
atropine  enough  to  antidote  the  toxic  effects,  and  supporting  meas- 
ures. Atropine  antidotes  physostigmine  more  effectually  than 
physostigmine  does  atropine. 


302  PHYTOLACCIN 

Van  Renterghem  recommends  doses  of  gr.  1-250  to  1-134  °f 
physostigmine  salicylate  or  sulphate  to  begin  with. 

The  daily  dose  of  physostigmine  should  not  exceed  gr.  1-50, 
divided,  for  an  adult. 

PHYTOLACCIN. 

Standard  granule — Gr.  1-6,  gm.  .01. 

Phytolaccin  is  a  concentration  from  Phytolacca  decandra,  or 
poke. 

The  chemistry  of  this  plant  is  obscure,  a  number  of  active  princi- 
ples having  been  assigned  it,  but  none  of  them  has  been  placed  on 
the  market  or  shown  to  represent  the  virtues  of  the  plant.  Our 
most  voluminous  information  concerning  it  comes  from  the  eclectics. 

Felter  and  Lloyd  say  that  phytolacca  acts  upon  the  skin  and  the 
glands,  especially  those  of  the  mouth,  throat  and  sexual  apparatus, 
and  most  markedly  on  the  breast.  It  also  acts  on  the  fibrous  and 
serous  tissues  and  the  digestive  and  urinary  mucosa.  It  is  elim- 
inated mostly  by  the  kidneys.  It  slows  the  heart  and  reduces  its 
force,  as  well  as  that  of  the  respiration.  It  paralyzes  the  cord,  act- 
ing principally  on  the  medulla.  Tetanic  convulsions  are  produced 
by  toxic  doses.  Death  results  from  paralysis  of  respiration.  In  full 
remedial  doses  it  acts  as  an  emetic  and  drastic  cathartic,  the  vomit- 
ing preceded  by  an  hour  of  suffering.  The  subsequent  purging 
lasts  long.  Large  doses  cause  violent  emeto-catharsis  with  mus- 
cular paralysis,  occasionally  spasms,  and  frequently  tingling  or 
prickling.  Dimness  of  vision,  diplopia,  vertigo  and  drowsiness  are 
caused  by  large  non-fatal  doses. 

Therapeutics. — Phytolacca  is  emetic,  cathartic,  narcotic  and  al- 
terative, advised  for  dyscrasia,  scrofula,  syphilis,  chronic  rheuma- 
tism ;  relieving  osteocopic  pains  better  than  opiates ;  destroys  the 
itch  acarus;  is  called  for  in  indolent  states  of  the  skin  with  vitiated 
blood;  chronic  eczema,  syphilides,  psoriasis,  tinea  capitis,  scaly, 
vesicular,  pustular  or  tuberculous  eruptions,  varicose  and  other  leg 
ulcers;  with  iridin  in  sycosis,  fissures,  fistulas,  boils,  carbuncles, 
dermal  abscesses,  and  ulcerations  at  the  outlets  of  the  body; 
tracheitis,  laryngitis,  influenza,  catarrh,  especially  with  diphtheritic 
tendency;  tonsillitis,  follicular  pharyngitis,  stomatitis,  aphthae, 
nursing  and  ordinary  sore  mouth,  and  syphilitic  faucial  ulcers ;  non- 
malignant  diphtheria;  chronic  tonsillar  hypertrophy;  goiter,  ozena 
and  nasal  catarrh;  pharyngeal  coughs;  the  best  remedy  for  hard 


PICRIC  ACID  303 

lymphatic  enlargements ;  acute  mastitis,  parotitis,  metastatic  mumps, 
orchitis,  sore  nipples,  the  tenderness  of  the  breasts  that  occurs  dur- 
ing menstruation,  ovaritis,  lymphoma,  subinvolution,  uterine  and 
vaginal  leucorrhea,  felons;  gastric  and  intestinal  glandular  ulcers; 
gonorrhea  and  nocturnal  irritability  of  the  bladder;  conjunctivitis, 
gonorrheal,  syphilitic  and  simple;  piles;  hydrophobia;  angina 
pectoris ;  many  headaches ;  asthenic  hyperemia  of  spleen,  liver  or 
uterus ;  albuminuria ;  with  iridin  in  abdominal  tuberculosis ;  obesity ; 
fatty  heart  if  rheumatic ;  locally  for  cancer  and  ulcers. 

Specific  indications. — Pale  mucosa  with  ulcers ;  sore  mouth  with 
small  blisters  on  tongue  and  buccal  mucosa;  white  sore  lips,  epi- 
dermis separating;  hard  sore  enlarged  glands;  mastitis,  orchitis, 
parotitis,  aphthae;  sore  breasts  with  impaired  breathing;  faucial, 
tonsillar  or  pharyngeal  ulcer;  pale  sore  throat  with  cough  or 
respiratory  disease ;  white  glaze  over  mouth,  in  children ;  white 
pultaceous  sloughs  at  mouth  corners  or  in  the  cheek,  and  diph- 
theritic deposits. 

In  case  of  poisoning  by  this  plant,  the  treatment  consists  in 
emptying  the  stomach,  and  keeping  up  the  respiration  by  hypo- 
dermics of  strychnine. 

Ellingwood  advises  phytolacca  in  the  angina  of  scarlet  fever, 
abdominal  pains  increased  by  pressure,  rectal  ails,  gastric  head- 
aches, the  irritation  from  teething,  and  in  pains  in  the  liver  with 
enlargement  and  induration  so  that  the  patient  cannot  lie  on  the 
right  side;  spasmodic  and  membranous  croup,  and  in  neuralgias. 

The  great  repute  in  which  phytolacca  is  held  was  originally 
based  on  its  remarkable  action  in  mastitis.  Many  times  the  \yriter 
has  applied  to  the  inflamed  breast  of  the  parturient  woman  the  ex- 
tract of  this  plant,  with  excellent  effect.  But  as  it  acts  through 
absorption  it  is  better  to  give  it  internally,  in  small  and  frequent 
doses.  Give  gr.  1-6  to  j  repeated  every  half-hour  till  slight  nausea 
begins  to  be  felt,  and  then  less  frequently.  Support  is  better  than 
any  remedial  drug  locally.  Do  not  let  the  nurse  rub  the  breast- 
it  is  sore  enough  already. 

As  a  remedy  for  obesity  phytolacca  owes  its  repute  to  advertis- 
ing. 

PICRIC  ACID. 

Assuredly,  picric  acid  must  have  friends,  for  it  continually  bobs 
up  as  a  remedy  for  something,  and  will  not  stay  buried.  Generally 


304  PICRIC  ACID 

it  is  as  a  remedy  for  malaria  internally,  or  for  burns  externally.  Let 
us*  see  what  there  is  to  be  said  of  it. 

Picric  acid,  trinitrophenol,C6H3(NO2)3,  is  obtained  by  treat- 
ing phenol  with  nitric  acid.  It  is  slightly  soluble  in  cold,  more  freely 
in  hot  water.  It  is  very  bitter.  It  imparts  a  yellow  color  to  the  tis- 
sues, urine,  skin  and  eyes,  which  is  removable  (when  locally  ap- 
plied) by  alcohol,  boric  acid,  or  strong  soap. 

Erb  credits  it  with  causing  nausea,  vomiting,  diarrhea,  emacia- 
tion, and  strongly  affecting  the  red  blood  cells. 

King  says  overdoses  cause  extravasations  of  blood  under  the  in- 
testinal mucosa,  with  flatulence,  depression,  twitching  of  the  mus- 
cles. 

Ellingwood  adds  to  the  list  of  toxic  effects  lowering  of  tempera- 
ture and  blood  pressure,  respiration  becoming  shallow,  heart  weak 
and  rapid,  painful  diarrhea  and  collapse.  Sometimes  convulsions 
precede  death.  The  leucocytes  are  increased  in  number. 

Therapeutics. — Picric  acid  has  been  frequently  recommended  for 
malaria;  reports  as  to  its  efficacy  vary.  King  limits  its  use  to 
cases  where  quinine  has  failed  or  ceased  to  be  beneficial.  He  speaks 
of  it  as  a  tonic-astringent,  useful  in  convalescence  from  acute  fevers, 
in  headaches,  chronic  diarrheas,  gastric  irritability  from  dyspepsia, 
anemias,  etc.  Ammonium  picrate  is  preferable  to  the  acid,  as  the 
latter  is  apt  to  cause  cramps.  In  malarial  debility  it  has  proved  use- 
ful, also  in  bilious  diarrheas,  and  as  a  sedative  to  spasmodic  coughs, 
either  whooping-cough  or  persistent  dry  hacking  with  dry  tongue 
and  throat  (Ellingwood). 

Webster  recommends  picric  acid  in  pernicious  anemias  and 
leukemia,  giving  very  small  doses. 

Clark  found  this  agent  useful  in  malarial  neuralgias,  but  that  it 
was  liable  to  cause  urticaria.  The  yellow  tint  of  shoe-linings  is  due 
to  picric  acid,  and  this  has  given  rise  to  painful  dermatitis,  with 
vesication. 

Shoemaker  speaks  of  the  application  of  a  6  per  cent  solution  for 
erysipelas.  A  saturated  watery  solution — about  j^  per  cent — has 
been  often  applied  to  burns  of  the  first  and  second  degree,  on  com- 
presses. As  it  dries,  the  same  solution  should  be  employed  to 
moisten  the  dressings  before  removal,  to  avoid  injury.  It  is  also 
applied  in  ointment  of  i  to  2  per  cent. 

Quinquaud  applied  this  acid  in  epithelioma ;  while  Calvelli  ad- 
vised it  in  chronic  eczema,  in  solution  of  i^  parts  in  250  of  distilled 
water. 


PICROTOXIN  305 

It  should  not  be  applied  to  extensive  burns,  as  it  will  cause 
toxic  effects  by  absorption. 

King  gives  the  dose  of  picric  acid  or  its  salts  as  gr.  y2  to  i,  three 
times  a  day.  Ellingwood  gives  that  of  ammonium  picrate  as  gr.  % 
to  y2,  while  Shoemaker  puts  it  at  gr.  y2  five  times  daily. 

The  acid  has  failed  as  a  remedy  for  trichina  and  intestinal 
worms,  and  Adler  tried  it  as  a  surgical  dressing  and  condemned  it. 

The  important  point  in  all  this  is  the  use  of  this  remedy  in  cases 
of  malaria  that  have  resisted  quinine,  and  where  the  latter  has  lost 
its  good  effect.  When  a  new  remedy  is  tried  in  such  conditions  and 
proved  beneficial,  it  is  sure  to  be  lauded  as  superior  to  the  ones 
formerly  used ;  when  in  point  of  fact  it  may  only  be  of  use  in  the  ex- 
ceptional cases,  or  when  the  worst  of  the  attack  is  past.  Thus  the 
iodides  acquired  an  undeserved  repute  in  rheumatism,  where  they 
are  only  of  value  in  the  subacute  stages ;  and  copaiba  forms  the  basis 
of  cough  remedies  that  succeed  "when  all  others  fail,"  because  that 
brings  the  case  along  to  the  stage  at  which  copaiba  is  of  use,  and  if 
given  too  soon  it  can  only  do  harm. 

The  picrate  of  iron  may  be  used  when  the  anemia  indicates  that 
metal,  in  doses  similar  to  those  of  the  ammonium  salt. 


PICROTOXIN. 

Standard  granule — Gr.  1-134,  gm.  .0005. 

Picrotoxin  is  a  glucoside  from  Cocculus  Indicus  or  fish  berries. 
It  has  some  relations  with  the  digitalin  group,  for  they  slightly 
stimulate  the  areas  around  the  medulla,  while  the  picrotoxin  group 
do  the  same  thing  more  powerfully,  though  they  do  not  affect  the 
heart  and  vessels  as  digitalin  does. 

Picrotoxin  may  cause  vomiting,  or  salivation,  fast  pulse  and 
respiration,  or  slow  pulse  and  palpitation.  Stupor  and  unconscious- 
ness follow  and  then  strong  convulsions,  tonic  and  then  clonic,  af- 
fecting the  limbs  and  jaws.  There  is  an  arrest  of  breathing  during 
the  spasms,  which  alternate  with  periods  of  quiet.  If  death  occurs 
it  is  from  asphyxia. 

The  action  is  exerted  mainly  on  the  medulla,  the  cerebrum  and 
cord  being  unaffected.  The  heart  is  slowed  by  stimulation  of  in- 
hibition mainly,  in  part  by  direct  action  on  the  heart.  The  marked 
rise  in  vascular  tension  is  also  due  to  centric  stimulation.  The  ac- 
celeration of  respiration  is  likewise  due  to  centric  stimulation.  Near 
death  the  breathing  may  become  slow  and  labored.  When  given  in 


306  PILOCARPINE 

doses  too  small  to  cause  convulsions  picrotoxin  lowers  the  tempera- 
ture. Its  mode  of  excretion  is  unknown. 

Picrotoxin  is  antidoted  by  chloroform  and  chloral ;  and  when  the 
respiration  is  weakened  by  chloral,  picrotoxin  restores  it,  raises  the 
blood  pressure,  and  cuts  the  sleep  short.  It  may  possibly  antidote 
morphine. 

Fish  berries  are  so  called  because  they  are  employed  to  catch 
fish.  The  powder  is  mixed  with  bread  and  dropped  in  the  water; 
fish  swallowing  the  dose  are  temporarily  stupefied  and  float  on  the 
surface  of  the  water.  Consciousness  is  soon  restored  and  the  flesh 
does  not  become  toxic  to  the  eater  of  the  fish.  A  tincture  of  coc- 
culus  is  also  used  to  destroy  lice.  Death  has  occurred  from  this  ap- 
plication. Cocculus  is  also  employed  as  an  adulterant  of  beer. 

Like  pilocarpine  picrotoxin  stimulates  the  secretions  and  is  anti- 
doted by  atropine. 

Therapeutics. — Picrotoxin  has  been  recommended  as  a  tonic  in 
dyspepsia, with  torpid  intestinal  walls;  it  relieves  flatulence  and  colic; 
gastralgia,  nausea,  dizziness  and  other  symptoms  of  poor  digestion. 
It  has  been  used  with  success  in  epilepsy,  chorea,  alcoholic  tremor, 
shaking  palsy,  migraine,  dysmenorrhea,  etc.  Anemic  nocturnal 
epilepsy  is  especially  benefited  by  this  remedy.  Profuse  sweating 
Sequent  to  influenza  was  checked  by  it  ( Semmola) .  Murrell  recom- 
mends it  in  the  night-sweats  of  phthisis  in  doses  of  gr.  1-67  at  bed- 
time or  three  times  a  day.  It  succeeds  when  even  atropine  fails. 

The  most  obvious  use  of  picrotoxin  would  be  as  a  respiratory 
stimulant  but  this  appears  to  have  been  neglected.  As  a  substitute 
for  pilocarpine  it  would  be  of  use  in  many  instances,  the  dose  being 
smaller  and  the  price  much  less. 

The  dose  of  picrotoxin  is  gr.  1-67  three  times  a  day,  or  half  this 
every  two  hours  till  effect. 

PILOCARPINE. 

Standard  granule — Gr.  1-67,  gm.  .001. 

Pilocarpine  is  a  liquid  alkaloid  derived  from  Pilocarpus  micro- 
phyllus,  or  jaborandi.  This  exists  in  the  plant  in  combination  with  at 
least  three  other  alkaloids,  jaborine,  jaboridine  and  pilocarpidine.  Of 
these  one  possesses  in  a  lesser  degree  the  qualities  of  pilocarpine  and 
the  others  oppose  this  action  through  its  whole  range.  The  relative 
proportions  and  actual  quantity  of  these  varies  in  the  plant  under  the 
various  conditions  under  which  it  grows,  and  which  group  prevails 


THERAPEUTIC   NOTES 


THERAPEUTIC    NOTES 


PILOCARPINE  307 

is  a  matter  to  be  determined  by  experiment.  It  was  a  case  of  this 
that  first  led  the  writer  to  the  study  and  use  of  the  alkaloids.  At- 
tending a  woman  in  confinement,  she  had  too  little  milk  for  her  babe, 
although  fully  strong  enough  to  afford  it  a  full  supply.  The  fluid 
extract  of  jaborandi  was  given  her  to  increase  the  flow  of  milk,  but 
next  day  she  had  none  at  all.  The  physician  charged  the  druggist 
with  having  made  a  mistake,  the  druggist  passed  the  charge  along 
to  the  manufacturer,  and  he  to  his  employees.  At  that  time  the 
chemistry  of  the  plant  had  not  been  studied  sufficiently  to  show 
wherein  the  trouble  lay. 

Physiologic  Action. — In  medicinal  doses  pilocarpine  causes  in  fif- 
teen minutes  flushing  of  the  skin,  and  either  salivation  or  sweating. 
Weakly  persons,  as  victims  of  organic  heart  disease  with  failing 
compensation,  are  more  apt  to  have  salivation ;  the  more  robust  the 
patient  the  more  likely  to  sweat.  The  sweating  from  a  full 
dose  is  very  profuse  indeed.  The  discharge  contains  an  increased 
quantity  of  the  solid  constituents  of  the  perspiration  as  well  as  the 
water.  It  includes  urea  also.  The  vascular  pressure  falls  and  the 
temperature  if  above  normal  falls  from  i  to  4  degrees.  Reichert 
found  that  the  production  and  the  dissipation  of  heat  were  at  first 
increased  and  later  decreased  by  pilocarpine.  Nearly  if  not  all  the 
secreting  glands  are  similarly  affected.  The  gastric  and  pancreatic 
secretions  are  largely  increased,  the  bile  less  so,  the  tears,  milk  and 
bronchial  mucus  augmented — so  much  so  that  full  doses  have  been 
followed  by  pulmonary  oedema. 

The  discharge  of  urea  by  the  kidneys  is  increased,  but  the  water 
is  lessened  by  the  loss  through  other  channels.  If  given  in  doses 
too  small  to  cause  sweating,  however,  pilocarpine  increases  the 
urinary  flow.  It  contracts  the  uterus  so  strongly  that  abortion  may 
result.  It  reduces  the  size  of  the  enlarged  spleen.  Children  are  less 
susceptible  than  adults  and  more  apt  to  show  the  salivary  effect,  es- 
pecially if  less  than  four  years  of  age  (Demme). 

Remy  tells  of  one  case  in  which  a  series  of  epileptic  attacks  fol- 
lowed the  use  of  this  agent.  Sudden  death  ensued  in  another  case. 

The  writer  once  gave  jaborandi  to  a  puerperal  woman  to  increase 
the  production  of  milk.  She  was  a  very  large,  portly  woman,  strong 
as  a  horse,  but  accustomed  to  the  daily  use  of  beer  in  moderation. 
In  this  instance  the  jaborandi  increased  the  secretion  of  milk  satis- 
factorily, but  in  a  few  days  the  patient  requested  the  physician  to 
have  her  confined  in  an  asylum  for  the  insane  as  she  could  not  much 
longer  resist  the  impulse  to  kill  her  husband  with  an  axe.  The 


308  PILOCARPINE 

jaborandi  was  discontinued  and  the  homicidal  impulse  subsided. 
The  milk  also  ceased  entirely,  as  had  been  the  case  at  each  previous 
accouchement. 

This  case  was  published,  and  some  years  later  a  Russian  journal 
published  a  report  from  a  physician  in  Siberia,  detailing  a  similar 
case,  and  quoting  that  recorded  by  the  writer.  Yet  this  does  not 
appear  to  be  a  direct  action  of  the  drug,  but  for  some  unknown 
reason  this  woman  could  not  supply  her  children  with  milk,  and  if 
any  other  means  had  been  employed  that  would  have  induced  a 
secretion  of  milk  the  same  mental  condition  would  have  supervened. 

Van  Renterghem  says  that  pilocarpine  excites  the  peripheric 
terminations  of  the  pneumogastric.  (The  statement  in  Shoemaker 
that  it  paralyzes  this  nerve  must  be  a  misprint.)  He  truly  places 
the  beginning  of  its  notable  action  at  three  minutes  from  the  time 
it  is  injected  subcutaneously.  Cerebral  tension  is  felt,  with  throb- 
bing arteries.  The  sweating  ceases  within  one  hour,  the  salivation 
continues  longer.  If  covered  up  in  bed  the  sweating  may  last  several 
hours.  Some  shivering  may  follow. 

Robin  found  the  average  flow  of  saliva  after  pilocarpine  to  be 
500  c.  c.  The  sweat  ejected  is  from  300  c.  c.  upwards — very  far. 
During  the  action  there  may  be  thirst,  anorexia,  nausea,  vomiting 
(rarely,  and  more  apt  to  occur  if  the  patient  has  eaten  shortly  be- 
fore taking  the  pilocarpine,  or  if  he  swallows  the  saliva),  slight  colic 
or  diarrhea.  The  desire  to  micturate  becomes  imperious,  even  pain- 
ful. Thirst,  anorexia,  dryness  of  the  skin  and  throat,  fatigue  and  de- 
pression, persist  some  time  after  the  sweating  has  ceased.  At  first 
the  pulse  gains  10  to  20  beats,  subsiding  towards  the  end  of  the 
sweating;  the  rhythm  may  be  disturbed,  if  the  heart  is  not  sound. 
Arterial  tension  is  but  little  lowered  by  strictly  therapeutic  doses. 
The  pupil  is  contracted  by  the  local  application  of  pilocarpine.  The 
intraocular  tension  is  lessened.  Not  only  is  the  intestinal  glandular 
secretion  increased  but  peristalsis  is  stimulated  (Albertoni).  The 
effect  on  the  uterus  is  greatest  at  the  end  of  pregnancy  (Lavrand). 

Six  grains  of  pilocarpine  were  dispensed  by  mistake  and  taken  in 
a  single  dose  by  an  adult.  The  symptoms  were  enormous,  but  had 
subsided  in  four  hours.  The  effects  of  this  agent  are  attributed  to  a 
stimulation  of  the  termini  of  the  excito-secretory  nerves ;  the  sub- 
stance intermediary  between  them  and  the  gland  cells  (Vulpian). 

Caustic  alkalies,  per  salts  of  iron,  metallic  salts  in  general,  are 
chemically  incompatible  with  pilocarpine.  Atropine  is  markedly 
antagonistic.  Muscarine,  nicotine,  apomorphine,  physostigmine  and 


PILOCARPINE  309 

picrotoxin,  are  to  a  greater  or  less  extent  analogous  in  their  action 
with  pilocarpine. 

Therapeutics. — As  a  diaphoretic  no  known  drug  equals  pilocar- 
pine. In  all  pulmonary  affections,  acute,  due  to  catching  cold,  a  full 
dose  of  pilocarpine  will  often  break  up  the  attack  if  taken  in  time.  In 
acute  exacerbations  of  chronic  respiratory  affections,  bronchitis, 
laryngitis,  the  debut  of  pneumonia,  pleurisy,  this  medication  is  well 
placed.  When  the  sputum  is  scanty  and  tough  pilocarpine  aids  by 
inciting  a  freer  secretion.  In  dropsies,  whenever  diaphoresis  is  ad- 
missible it  is  the  most  effective  agent  at  our  command.  In  nephritic 
cases  it  is  equally  available  when  uremia  threatens,  since  it 
eliminates  urea  through  the  skin. 

In  the  dropsy  following  scarlet  fever  pilocarpine  has  proved  ex- 
cellent. Cardiac  dropsy  does  not  come  under  its  rule — weak  hearts 
contraindicate  it.  In  many  skin  diseases  pilocarpine  has  been  em- 
ployed with  varying  results.  As  a  remedy  for  itching  it  has  no 
superior.  The  itching  of  jaundice  is  completely  relieved  except  that 
due  to  cancer  of  the  liver.  The  substitutive  action  of  pilocarpine  is 
often  of  value  here,  and  the  aid  given  the  eliminants  renders  it  use- 
ful in  all  cutaneous  maladies  traceable  to  the  effort  of  the  skin  to 
supplement  the  action  of  kidneys  unequal  to  their  task.  By  this 
means  we  may  obtain  temporary  relief  and  time  to  institute  the 
methods  that  tend  to  cure  by  equalizing  the  tasks  with  the  capacity. 

The  eruptive  and  other  essential  fevers  may  afford  a  field  for  this 
drug  as  yet  unsurveyed.  The  writer  has  employed  pilocarpine  for 
twenty  years  as  a  specific  for  sthenic  erysipelas  without  finding  a 
case  it  failed  to  control.  The  first  case  was  a  stout  Irish  woman  with 
facial  erysipelas,  bright  red  eruption,  high  fever,  some  delirium. 
Pilocarpine  was  given  until  slight  action  was  noticeable,  by  which 
time  the  eruption  had  begun  to  pale  and  recede.  When  it  had  been 
reduced  to  an  inch  the  medicine  was  suspended,  and  at  once  the 
erysipelas  began  to  spread.  Again  and  again  the  drug  was  given  till 
nearly  well,  and  suspended  till  the  redness  was  evidently  spreading, 
until  we  were  completely  satisfied  that  pilocarpine  controlled  that 
disease  as  we  control  a  trotter  with  the  lines.  Then  the  medicine 
was  given  till  the  eruption  had  completely  disappeared.  This  ex- 
perience was  repeated  with  every  succeeding  case  of  erysipelas  for 
years,  till  we  met  a  case  of  asthenic  form,  eruption  pale,  no  fever, 
heart  weak  from  fatty  degeneration,  whole  system  depressed.  No 
tendency  to  sweating  was  manifest  under  pilocarpine,  which  de- 
pressed still  more.  This  patient  responded  at  once  and  strongly  to 


310  PILOCARPINE 

dram  doses  of  tincture  of  chloride  of  iron  every  four  hours.  Since 
then  the  writer  has  met  no  case  of  erysipelas  that  did  not  quickly 
respond  to  pilocarpine  if  sthenic,  and  iron  if  asthenic. 

We  must  emphasize  the  use  of  pilocarpine  in  the  beginning  of 
acute  pleurisies.  Empty  the  bowels  freely  and  fully,  give  a  full  dose 
of  pilocarpine,  enough  to  cause  profuse  sweating,  and  forbid  all  food 
and  drink.  The  blood  vessels  will  be  drained  of  serum,  the  surplus 
will  flow  out  of  the  hyperemic  capillaries,  and  the  attack  be  jugu- 
lated. The  same  applies  to  all  acute  affections  due  to  catching  cold. 
The  abstinence  is  essential. 

Pilocarpine  has  been  employed  in  several  ocular  maladies,  sub- 
acute  and  chronic ;  as  a  myotic  it  is  unequal  to  eserine ;  as  promotive 
of  absorption  it  is  indicated  in  iridochoroiditis,  and  iritis  serosa, 
glaucoma,  detachment  of  the  retina,  etc. 

Schuller  reported  some  cases  in  which  pilocarpine  had  strongly 
stimulated  the  growth  of  the  hair,  curing  alopecia  and  restoring 
gray  hair  to  its  original  color.  Success  and  failure  have  been  re- 
ported as  to  this  suggestion,  and  as  yet  the  proper  cases  for  this 
remedy  have  not  been  differentiated. 

So  also  in  deafness — some  cases  have  been  cured  by  pilocarpine 
and  others  resist  its  influence — labyrinthine  disease  and  dry  catarrhs 
(Politzer). 

Some  cases  of  diphtheria  have  been  recorded  where  the  full  ef- 
fect of  pilocarpine  has  been  heralded  by  the  separation  of  the  mem- 
brane. But  the  depression  is  to  be  taken  into  account,  and  if  used 
the  remedy  must  be  carefully  watched.  At  present  the  use  of  anti- 
toxin is  preferable. 

Mumps  is  often  jugulated  by  this  agent  in  full  dose.  In  diabetes 
insipidus  the  flow  of  urine  is  quickly  lessened  by  it.  Hiccough, 
asthma,  hysteria,  hystero-epilepsy,  mania,  whooping-cough,  am- 
blyopia,  amaurosis,  opacities  in  the  vitreous  humor,  otitis  media, 
oedema  of  the  glottis,  the  dry  mouth  of  diabetes  mellitus  and  that 
due  to  atropine,  albuminuria  of  pregnancy,  eclampsia,  fulgurant 
pains  of  ataxia,  hydrophobia,  unilateral  sweating,  and  the  night 
sweats  of  phthisis,  are  some  of  the  maladies  in  which  this  remedy 
has  succeeded.  It  is  one  of  the  best  and  quickest  means  of  breaking 
up  the  chill  of  malaria.  A  forming  attack  of  influenza  is  quickly 
jugulated  by  a  full  dose  of  pilocarpine,  enough  to  cause  free  sweat- 
ing. This  alkaloid  has  been  advised  for  many  forms  of  blood  in- 
fection, by  venomous  insects,  snakes,  even  for  hydrophobia,  and  for 
the  effects  of  such  toxic  plants  as  rhus  toxicodendron.  It  has  been 


PIPERINE  311 

claimed  that  pilocarpine  will  abort  an  attack  of  gonorrhea  if  given 
at  the  beginning,  before  the  discharge  has  become  purulent.  In  all 
these  affections  a  full  dose  is  requisite,  enough  to  cause  free  sweat- 
ing or  salivation.  It  is  even  advisable  to  give  this  remedy  in  this 
manner  at  the  very  outbreak  of  smallpox,  scarlet  fever  and  measles. 
Pilocarpine  is  preeminently  a  remedy  for  the  Burggraevian 
method  of  dosage.  To  an  adult  it  should  be  given  in  hot  water,  in 
doses  of  gr.  1-67  to  1-33,  repeated  every  five  minutes  till  the  desired 
effect  is  manifest.  This  avoids  the  danger  or  inconvenience  of  an 
overdose,  and  as  the  effects  are  as  quickly  shown  as  when  given 
hypodermically,  no  time  is  lost.  But  when  there  is  question  of 
aborting  a  dangerous  chill  give  gr.  1-6  by  hypodermic.  With  chil- 
dren, heart  cases  and  weakly  adults,  give  only  by  the  careful  method 
first  advised  and  watch  closely.  In  erysipelas  give  till  slight  sweat- 
ing begins  and  then  enough  to  keep  up  this  effect.  For  deafness, 
alopecia  and  chronic  maladies  in  general,  ascertain  the  dose  requisite 
for  full  effect  by  cumulative  administration,  and  then  give  this 
quantity  in  a  single  dose  at  bedtime  thereafter. 

PIPERINE. 

Standard  granule — Gr.  1-6,  gm.  .01. 

Piperine  is  an  alkaloid  from  Piper  nigrum,  black  pepper.  It  is 
almost  insoluble  in  water,  soluble  in  30  parts  alcohol,  I  part  boiling 
alcohol,  very  soluble  in  hot  acetic  acid,  slightly  in  ether,  soluble  in 
chloroform,  carbon  bisulphide  and  benzole.  When  pure  it  is  almost 
tasteless,  on  account  of  its  insolubility;  but  in  solution  it  develops 
the  sharp  pungency  of  pepper. 

Like  pepper  itself,  piperine  causes  a  sense  of  warmth  in  the 
stomach,  increases  the  appetite,  the  digestion,  the  secretion  of 
gastric  juice  and  the  gastric  and  intestinal  peristalsis.  Overdoses 
cause  gastroenteritis,  as  too  long  or  concentrated  applications  to  the 
skin  occasion  dermatitis.  Doses  of  37^  grains  caused  burning  of 
the  eyes,  palms  and  soles,  then  in  all  the  limbs,  with  alternate  sensa- 
tions of  cold  and  heat,  changing  their  location.  Heart-action  was 
not  modified  (Neumann  and  Chiappa).  Mosler  found  that  in  dogs 
it  caused  a  decided  reduction  in  the  size  of  the  spleen,  with  slight 
fall  of  temperature.  Although  doubtless  eliminated  by  the  kidneys 
analysis  has  not  detected  piperine  or  the  products  of  its  decomposi- 
tion in  the  urine. 

Piperine  has  antimalarial  properties  and  has  been  employed  as  a 
remedy  for  ague  but  is  now  used  simply  as  an  adjuvant  to  quinine. 


312  PODOPHYLLIN.     PODOPHYLLOTOXIN 

It  has  also  been  employed  as  an  internal  remedy  for  hemorrhoids. 
Colics  and  diarrheas  are  relieved  by  it  as  by  any  carminatives ;  and  it 
forms  a  valuable  ingredient  of  the  powerful  mixtures  employed  to 
break  up  by  local  action  the  attacks  of  cholera,  dysentery,  and  con- 
gestive chills.  In  scarlet  fever  it  may  be  given  to  stimulate  the 
vitality  of  the  tissues  of  the  throat.  In  chronic  gonorrhea  the  local 
stimulus  of  this  agent  as  eliminated  by  the  urine  may  arouse  the 
vital  resistance  to  morbific  action  and  thus  promote  a  cure.  It  will 
be  seen  that  except  in  ague  the  effect  is  that  of  a  local  stimulant  and 
vital  incitor;  and  it  is  questionable  if  the  oleoresin  of  pepper  is  not  a 
better  remedy.  The  uses  of  piperine  other  than  for  this  local  action 
have  never  been  studied. 

Astringents  render  piperine  inert. 

Blom  advised  piperine  in  malarial  fevers  in  phlegmatic  subjects, 
with  digestive  torpor;  finding  it  superior  to  quinine  and  to  salicin  in 
them.  In  catarrhal  and  rheumatismal  forms  it  was  contraindicated. 

Several  authors  speak  of  piperine  as  stimulating  the  sexual  ap- 
petite. 

Burggraeve  prescribed  piperine  for  .chronic  discharges.  Van 
Renterghem  cured  a  case  of  gleet  in  three  weeks  with  piperine,  gr. 
Y$  every  hour.  As  a  febrifuge  the  dose  may  be  placed  at  a  grain 
every  hour  for  an  adult.  As  a  gastric  stimulant  give  a  grain  before 
meals,  to  be  chewed,  not  swallowed  whole. 


PODOPHYLLIN.     PODOPHYLLOTOXIN. 

Standard  granules — Podophyllin — Gr.  1-67;  gm.  .001;  gr.  1-12,  gm.  .005; 
gr.  1-6,  gm.  .01;  podophyllotoxin ;  gr.  1-12,  gm.  .005. 

Podophyllin  is  a  resin  derived  from  Podophyllum  peltatum,  the 
may-apple.  It  is  soluble  in  alcohol,  insoluble  in  water.  It  consists 
of  an  inert  resinous  acid  and  podophyllotoxin,  a  white,  resinous 
amorphous  powder,  very  bitter,  soluble  in  diluted  alcohol  and  in  hot 
water.  According  to  Podwissotzky  podophyllotoxin  consists  of 
picropodophyllin,  the  true  active  principle,  which  is  rendered  solu- 
ble by  the  accompanying  picropodophyllrc  acid.  He  therefore  pre- 
fers podophyllotoxin  as  a  remedial  representative  of  the  drug. 

Felter  and  Lloyd  pronounce  podophyllum  a  certain  but  slow 
cathartic.  Small  repeated  doses  short  of  catharsis  induce  ptyalism. 
It  increases  the  bile  and  intestinal  secretions;  causes  griping,  is 
aided  by  salt,  and  does  not  leave  constipation  in  its  wake.  Large 
doses  occasion  violent  emetocatharsis.  Overdoses  have  caused 


THERAPEUTIC   NOTES 


THERAPEUTIC    NOTES 


PODOPHYLLIN.     PODOPHYLLOTOXIN  313 

death.  When  given  unnecessarily  to  improper  subjects  it  has  oc- 
casioned gastroenteritis.  The  above  named  authors  recommend 
podophyllum  in  syphilis,  rheumatism  and  scrofula  in  doses  too 
small  to  act  on  the  bowels;  atonic  dyspepsia,  gastric  and  intestinal 
catarrh,  atonic  indigestions,  with  dizziness,  anorexia  and  heavy 
headache,  indisposition  to  exertion,  dirty  flabby  tongue,  and  fullness 
of  the  superficial  veins,  the  abdomen  and  tissues  in  general ;  gastric 
disturbances  due  to  torpid  liver;  chronic  hepatitis;  habitual  con- 
stipation especially  if  due  to  portal  engorgement  (small  and  con- 
tinued dosage)  ;  bilious  and  malarial  fevers  (not  now  so  employed)  ; 
in  dropsy,  with  potassium  bitartrate;  dysmenorrhea,  amenorrhea, 
incontinence  of  urine,  worms  and  some  affections  of  the  bladder. 

Specific  Indications. — Fullness  of  tissues,  especially  of  super- 
ficial veins ;  oppressed  full  pulse ;  dirty  yellow  tongue,  and  dizziness. 
Contraindicated  by  pinched  features  and  tissues,  contracted  skin  and 
tongue. 

These  authors  treat  of  podophyllin  under  a  separate  head,  as  a 
distinct  remedy.  As  a  cathartic  it  requires  4  to  8  hours  to  purge, 
and  the  action  may  last  two  days.  It  maintains  a  constant  moisture 
of  the  skin.  Alkalies  with  aromatics  check  over-catharsis.  Tritura- 
tion  with  milk  sugar  increases  its  cathartic  action  and  renders  it 
less  griping.  Foods  of  difficult  digestion  should  not  be  taken  during 
its  administration.  Podophyllin  is  used  mostly  in  small  non- 
cathartic  doses  as  a  stimulant  to  the  sympathetic  nervous  system : 
acting  mainly  on  the  parts  supplied  by  the  solar  plexus.  It  improves 
digestion  and  blood-making,  stimulating  normal  excretion.  "It  ex- 
erts a  peculiarly  specific  action  on  all  forms  of  stomach  and  bowel 
trouble  with  atony,  characterized  by  full  and  relaxed  tissues,  with 
mucous  discharge."  In  summer  disorders  of  children,  especially 
cholera  infantum,  with  mucoid  slimy  stools ;  motion  sluggish,  tongue 
yellowish  white,  superficial  veins  full,  face  dull.  In  chronic  maladies 
with  feeble  digestion,  not  responding  to  tonics,  usually  atony  of  upper 
small  bowel;  for  constipation,  costiveness  of  infants  or  aged;  stools 
hard,  grayish  white  or  clayey,  floating  on  water,  also  for  dry  stools 
with  tympanites  and  wandering  colicky  pains;  flatulent  colic  of 
children  with  constipation ;  dysentery  and  acute  or  chronic  diarrhea 
with  portal  sluggishness,  dyspepsia  with  thickened  mucous  tissues 
secreting  freely,  head  full,  tissues  full  and  "doughy,"  veins  same, 
skin  sodden,  tongue  fully  coated  dirty ;  cardialgia  with  constipation ; 
hepatic  disorders,  biliousness,  dizziness,  bitter  taste,  acholic  stools, 
bilious  vomiting;  acute  and  chronic  hepatitis,  hepatic  fullness,  in- 


314  PODOPHYLLIN.     PODOPHYLLOTOXIN 

frascapular  aching,  ache  in  back  of  neck,  with  dizziness ;  in  jaundice 
with  clayey  stools  alternate  with  chionanthus  ;  biliary  calculi ;  hemor- 
rhoids dependent  on  hepatic  torpor  (alternate  with  sulphur)  ;  cough 
of  bronchorrhea  with  gastric  catarrh ;  heart  disease  with  hepatic 
torpor;  rheumatism  when  patient  is  sallow  and  inactive,  with  full- 
ness of  tissues,  dull  pain  and  heaviness  in  liver ;  in  renal  diseases 
with  the  usual  indications  present ;  pustular  conditions,  eczema  and 
cracked  or  fissured  skin  (Ellingwood)  ;  deep-seated  pain  in  sciatic 
notch  (Scudder)  ;  non-intestinal  inflammations  with  constipation; 
brain  disorders  and  dropsy  require  large  doses  as  derivative;  in 
malaria  alternate  with  cinchona;  cathartic  doses  are  necessary  in 
biliary  calculi,  apoplexy,  dropsy  and  some  inflammations.  Younkin 
advises  them  in  gonorrheal  epididymitis. 

Ellingwood  says  this  agent  is  indicated  in  inactive  conditions 
of  the  gastrointestinal  tract,  heavily  coated  tongue,  thick,  broad  and 
pale ;  dirty  yellow  especially  at  the  base ;  perhaps  vertigo,  complete 
anorexia,  and  dull  heavy  headache ;  the  circulation  full  and  sluggish, 
abdominal  viscera  plethoric.  Whatever  the  disease  these  conditions 
indicate  the  employment  of  this  remedy.  Always  give  in  doses  too 
small  to  develop  the  irritative  or  cathartic  effect. 

Cushny  says  podophyllotoxin  causes  glomerular  nephritis  and 
hemorrhages  into  various  organs  when  given  subcutaneously  or  in- 
travenously in  large  doses. 

Shoemaker  recommends  podophyllin  in  sick  headache  with  loose 
dark  stools ;  in  recurring  tonsillitis,  etc. 

Synergists  are  euonymin,  leptandrin,  iridin,  which  with  quassin 
and  caffeine  have  cholagog  properties ;  purgatives  all  aid  that  action 
of  podophyllin ;  atropine  prevents  griping  and  combats  the  intestinal 
spasm  that  hinders  purgation. 

As  a  purgative  podophyllin  is  too  slow  and  too  violent  for  ust 
when  there  are  so  many  better  agents  of  this  class.  The  special  in- 
dication followed  by  the  writer  for  years  has  been  its  prescription 
when  the  stools  are  dark  colored  and  offensive.  Here  the  dose 
should  not  exceed  gr.  1-12,  given  at  bedtime,  which  will  act  in  12 
to  14  hours.  It  may  be  repeated  twice  a  week  if  needed.  We  never 
exceed  that  dose. 

The  uses  of  this  agent  in  still  smaller  doses  as  advised  by  the 
eclectics  quoted  seem  worthy  of  study  and  experimentation.  Too 
often  we  base  our  ideas  of  a  drug-action  solely  on  its  toxic  effects 
and  ignore  the  use  of  it  in  doses  too  small  to  develop  such  gross  in- 
terference with  the  animal  economy. 


POPULIN.    POTASSIUM    BICHROMATE  316 

Podophyllin  is  variable  in  strength  and  it  would  be  wise  to  sub- 
stitute podophyllotoxin,  which  is  uniform  and  the  dose  is  smaller. 
The  only  reason  this  has  not  been  done  by  American  alkalometrists 
is  that  the  podophyllin  furnished  the  profession  is  so  pure  and  uni- 
form that  the  need  for  a  better  preparation  has  not  been  seriously 
felt.  But  if  prescribed  to  be  filled  by  the  pharmacist  from  any  podo- 
phyllin he  may  happen  to  have  on  hand,  it  would  be  better  to  sub- 
stitute the  more  certain  form  of  the  drug. 

The  granules  of  podophyllin  containing  gr.  1-67  each  are  well 
suited  for  the  uses  described  by  Lloyd.  One  granule  before  meals 
and  at  bedtime,  will  suit  most  cases.  The  granule  of  podophyl- 
lotoxin is  far  too  strong.  One  of  gr.  1-67  to  1-134  would  be  quite 
satisfactory. 

POPULIN. 

Standard  granule — Gr.   1-6,  gm.  .01. 

Populin  is  a  concentration  from  the  bark  of  the  white  poplar, 
or  American  aspen,  Populus  tremuloides.  Poplar  bark  contains  two 
glucosicles,  populin  and  salicin. 

Felter  and  Lloyd  say  that  this  bark  is  tonic  and  febrifuge,  and 
has  been  used  for  ague  with  benefit.  As  a  tonic  it  is  employed  for 
emaciation  and  debility,  in  convalescence ;  disorders  of  the  reproduc- 
tive system,  impaired  digestion,  chronic  diarrhea,  and  against  lum- 
bricoids ;  as  a  diuretic  in  urinary  affections,  gonorrhea,  gleet,  and 
for  granular  kidney.  It  is  useful  for  irritable  bladder  with 
tenesmus,  if  given  in  very  small  doses.  Webster  suggests  its  use 
for  uterine  congestion  and  for  hypertrophied  prostate. 

Specific  Uses. — Marked  debility  with  impaired  digestion;  tenes- 
mic  vesical  irritation ;  tenesmus  after  urination. 

The  presence  of  salicin  gives  populin  a  sedative  action  on  the 
sexual  function  and  appetite  which  may  be  useful. 

The  dose  is  from  gr.  1-6  to  i  before  meals  and  at  bedtime. 

POTASSIUM   BICHROMATE. 

Standard  granule — Gr.  1-67,  gm.  .001. 

Potassium  bichromate  has  been  recommended  as  an  alterative 
against  scrofula  and  syphilis,  but  is  now  employed  simply  as  a 
remedy  for  some  respiratory  conditions.  The  effects  are  said  to  be 
confined  to  the  throat  and  bronchi,  with  the  larynx,  not  extending  to 
the  bronchioles.  Hoarseness  and  cough  are  the  indications  for  its 


316  POTASSIUM  PERMANGANATE 

exhibition.  These  may  appear  in  laryngitis  from  strain  or  cold, 
diphtheria,  croup,  any  inflammation  of  the  region  described  with 
tendency  to  low  grades  of  deposit.  It  has  also  been  recommended 
for  muscular  pains,  chronic  non-febrile  rheumatism,  mucoenteritis 
and  acute  diarrhea  occurring  in  cold  weather  (Webster)  ;  chronic 
diarrheas  and  dysenteries  as  a  recuperative;  and  in  dyspepsia  with 
yellow  coated  tongue  and  gastric  catarrh. 

Specific  Indications. — Respiratory  irritation  with  hoarseness, 
harsh  or  croupal  cough,  scanty  or  thick  tenacious  sputa,*  difficult 
respiration,  subacute  inflammation ;  low  grade  inflammatory  de- 
posits; mucoenteritis  and  irritative  diarrhea  with  tenesmus,  dys- 
pepsia with  gastric  catarrh  and  yellow  tongue;  corneal  ulcers  with 
stringy  discharge,  croupous  conjunctivitis,  trachoma  with  tenacious 
discharges ;  non-inflammatory  rheumatic  or  muscular  pain ;  pseudo- 
membranous  croup;  laryngeal  irritation  and  hoarseness  from  sing- 
ing or  speaking  (Felter  and  Lloyd). 

Shoemaker  speaks  of  this  as  a  remedy  for  tonsillitis  where  the 
onset  is  rapid,  tonsils  rough,  raw  and  angry  looking,  with  muco- 
purulent  secretions  exuding  from  the  follicles,  and  in  non-diph- 
theritic pseudomembranous  tonsillitis ;  where  Weaver  considers  it  a 
specific. 

Abbott  recommends  this  agent  as  an  expectorant,  a  relaxant  in 
croup  and  capillary  bronchitis,  and  says  that  in  the  third  stage  of 
pharyngitis  it  acts  like  a  charm. 

The  dose  is  gr.  1-67  every  half-hour  to  two  hours ;  in  croup  and 
capillary  bronchitis  this  dose  every  ten  minutes,  in  hot  water. 

POTASSIUM   PERMANGANATE. 

Standard  granule — Gr.  1-4,  gm.  .015. 

When  brought  into  contact  with  any  albuminous  tissue,  perman- 
ganate of  potassium  loses  a  part  of  its  oxygen  instantly.  This 
renders  it  destructive  to  the  protoplasm  with  which  it  comes  in  con- 
tact. And  the  certainty  of  its  decomposition  the  moment  it  touches 
the  walls  of  the  stomach  has  led  many  to  deny  the  reports  of  its  ef- 
ficacy in  anemic  amenorrhea.  Nevertheless  there  is  abundant 
evidence  as  to  its  efficacy  in  this  malady.  No  other  preparation  of 
manganese  has  won  repute  in  this  disease ;  but  we  have  not  been  able 
to  find  any  evidence  that  any  other  salt  of  this  metal  has  been  suf- 
ficiently tried. 

A  physician  told  the  writer  he  had  discovered  a  most  valuable 


QUASSIN  317 

remedy  for  phthisis ;  but  that  just  as  he  had  begun  to  see  the  cure 
of  the  cases  within  reach,  they  always  were  taken  with  serious  or 
even  fatal  pulmonary  hemorrhages.  It  was  suggested  to  him  that 
his  remedy  was  potassium  permanganate,  and  he  acknowledged  that 
this  was  true.  The  recognition  was  based  on  a  belief  in  the  power 
of  this  agent  to  induce  hemorrhages  where  due  and  in  these  cases  it 
was  most  likely  to  occur  through  the  thin  walls  of  the  pulmonary 
capillaries.  In  amenorrhea  the  uterus  is  most  apt  to  bleed,  hence  its 
effect  in  anemic  amenorrhea. 

Let  the  patient  take  iron  arsenate  during  the  intermenstrual 
period,  beginning  four  days  before  the  expected  flow  to  take  potas- 
sium permanganate  in  doses  of  gr.  l/^  every  two  to  four  hours,  and 
continuing  till  the  discharge  appears  or  the  time  is  past.  If  it  does 
not  appear  it  is  evident  that  the  supply  of  blood  is  insufficient  to 
afford  the  loss,  and  this  must  be  made  up  by  proper  treatment  and 
diet. 

Potassium  permanganate  has  been  used  with  some  benefit  in 
diabetes  mellitus,  diphtheria,  scarlet  fever,  and  other  essential  fevers, 
on  the  theory  of  its  oxidizing  cowers.  In  cholera  and  acute  rheu- 
matism its  value  seems  less  likely.  As  a  remedy  for  morphine 
poisoning  it  has  also  been  exploited — dose  up  to  full  toleration.  It 
has  been  much  used  locally. 

ftTJASSIN. 

Standard  granules— Gr.  1-67,  gm.  .001 ;  gr.  1-12,  gm.  .005. 

Quassin  is  a  glucoside  from  the  Quassia  amara.  From  a  kilo- 
gram of  quassia  wood  Adrian  and  Moreaux  obtained  1.25  to  1.50 
grams  of  quassin.  It  is  intensely  bitter,  slightly  soluble  in  water, 
freely  in  alcohol. 

In  small  doses  quassin  possesses  the  virtues  of  the  simple  non- 
astringent  bitters.  Taken  into  the  mouth  it  increases  the  flow  of 
saliva,  and  moderates  thirst  even  during  the  summer  heat.  It 
arouses  the  appetite.  Digestion  is  hastened,  and  this  seems  to  be 
difficult  of  explanation,  since  the  secretion  of  gastric  juice  is  not 
increased  or  even  hastened.  Probably  it  is  a  secondary  effect  to  the 
arousing  of  appetite.  But  if  given  on  an  empty  stomach  and  not 
followed  by  food,  quassin  is  followed  by  a  sense  of  discomfort,  and 
acid  regurgitations. 

In  doses  of  gr.  *4  Campardon  found  quassin  to  cause  severe 
headache,  burning  pain  in  the  oesophagus  and  pharynx,  nausea, 


318  QUASSIN 

vertigo,  restlessness,  diarrhea,  ardor  urinae  with  lessened  excretion. 
Potter  states  that  a  concentrated  solution  caused  serious  symptoms 
of  narcotism  in  a  child  four  years  old.  Its  solutions  are  very  de- 
structive to  flies  and  insects,  and  to  ascarides. 

Under  the  influence  of  regular  medicinal  doses  of  quassin  the 
stools  become  more  regular,  from  the  tonic  influence  of  the  remedy 
on  the  intestinal  musculature.  Possibly  the  intestinal  secretion  is 
also  increased,  if  there  has  been  deficient  secretion  from  atony. 
Diarrhea  continuing  from  atony  is  likewise  checked  by  quassin. 
Nutrition  is  furthered  indirectly  by  the  improvement  in  the  diges- 
tion, not  otherwise. 

Sousa  Refoios  found  that  very  large  doses  injected  into  a  dog 
caused  convulsive  tremblings.  Haertel  applied  the  alcoholic  extract 
of  quassia  to  wounds  of  the  thigh  of  rabbits,  and  found  it  caused 
their  death. 

Kurtz  noted  temporary  paralysis  of  the  posterior  extremities  fol- 
lowing lavage  of  an  ulcer  in  an  animal,  with  infusion  of  quassia. 
The  administration  of  quassia  in  large  doses  long  continued  caused 
in  a  man  amaurosis  (Kurtz),  amjjlyopia  (Kraus),  involuntary 
spasmodic  movements  in  very  irritable  women  (Barbier). 

An  enema  of  quassia  given  an  infant  caused  pallor,  small  pulse, 
shallow  respiration,  debility  and  vomiting;  the  life  being  saved  by 
energetic  stimulation  (Reckit). 

Compardon  concluded  from  his  studies  of  the  quassins  that  they 
activated  and  augmented  the  secretions  of  the  salivary  glands,  liver, 
kidneys  and  perhaps  the  mammary  glands ;  aroused  the  action  of 
the  gastrointestinal  musculature,  of  the  uropoietic  apparatus,  the  bile 
ducts,  increasing  the  mucous  secretions  and  facilitating  the  normal 
excretions ;  during  illness  they  increased  the  appetite,  •  renewed  the 
forces,  facilitated  normal  excretion,  rendered  defecation  easier,  and 
hastened  the  expulsion  of  renal  and  of  hepatic  calculi ;  with  healthy 
as  well  as  sick  men  they  determined  in  a  certain  dose  toxic  effects 
recalling  the  action  of  the  strychnine  group ;  quassin  amorphous  in 
doses  above  2^  grains,  and  the  crystallized  in  doses  above  gr.  %, 
caused  symptoms  of  intoxication,  local  or  general,  such  as  nausea, 
vomiting,  diarrhea,  vertigo,  febrile  agitation,  cramps,  and  con- 
vulsions, for  which  it  was  necessary  to  use  chloral  internally  and 
chloroform  externally  (by  inhalation?). 

Therapeutics. — Quassin  has  been  employed  largely  for  the  pur- 
pose of  stimulating  digestion  and  the  flow  of  bile.  It  is  indicated, 
says  Van  Renterghem,  in  labored  and  slow  digestion,  stomachal  and 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


QUASSIN  •  319 

intestinal,  in  all  morbid  states  accompanied  by  defective  biliary 
secretion,  in  chronic  intestinal  catarrh  due  to  the  presence  of  badly 
digested  food,  and  in  lienteric  cases.  He  prefers  the  granules  of  gr. 
1-67  each,  silver  coated,  to  cover  the  bitterness ;  and  as  an  eupeptic 
gives  one  or  two  to  an  infant,  three  or  four  to  an  adult,  a  little  be- 
fore the  principal  meals.  Burggraeve  loved  to  associate  with 
quassin  the  arsenate  of  soda,  in  like  doses,  and  this  combination  is  a 
happy  one.  The  salts  of  arsenic  in  the  small  doses  increase  the  ap- 
petite, activate  the  digestive  functions,  and  act  as  antiputrefactives. 
This  is  the  direct  action,  but  their  role  is  not  ended  here.  From  the 
moment  they  enter  the  circulation  they  exercise  their  modifying  ac- 
tion on  the  nutrition,  tonifying  the  tissues,  and  preventing  the  im- 
poverishment of  the  blood,  thus  indirectly  contributing  to  the  cure 
of  the  dyspepsia. 

Given  as  a  cholagog,  Van  Renterghem  prescribes  quassin  in 
doses  of  a  granule  or  two  every  hour,  alone  or  with  caffeine,  podo- 
phyllin,  euonymin,  iridin,  leptandrin  or  sodium  sulphate.  In  lienteria 
the  best  auxiliary  is  surely  magnesia  sulphate  in  purgative  doses, 
given  in  early  morning,  then  according  to  the  indications  followed 
by  naphthalin,  bismuth  subnitrate,  cotoin,  strychnine,  hyoscyamine, 
etc. 

Like  all  the  bitters  quassin  has  some  good  influence  in  remittent 
and  intermittent  fevers.  It  preserves  animal  matters  from  decay. 
It  has  been  employed  as  a  remedy  for  alcoholism;  and  to  destroy 
the  appetite  for  liquor. 

In  France  quassin  forms  one  of  the  ingredients  of  the  liquid 
served  as  a  beverage  to  school  children,  which  contains  also  licorice 
and  a  trace  of  phosphoric  acid;  the  object  being  to  discourage  ex- 
cessive drinking  in  summer.  This  effect  of  relieving  thirst  has  not 
received  the  attention  it  deserves  on  this  side  the  Atlantic.  The 
French  dosimetrists  also  employ  quassin  to  a  large  extent  as  a 
general  toner  and  vital  inciter  where  we  use  the  more  and  un- 
necessarily powerful  strychnine — and  here  we  might  with  advantage 
follow  their  example,  holding  the  strychnine  in  reserve  for 
emergencies  worthy  of  its  powers,  and  discouraging  the  popular 
tendency  to  make  of  it  a  stimulant  for  lay  self-prescribing  whenever 
such  an  agent  is  supposed  to  be  needed.  Strychnine  should  be  held 
strictly  in  the  control  and  possession  of  the  physician. 

We  cannot  agree  with  our  French  brethren  as  to  the  best  manner 
of  administering  the  bitters.  A  quassia  cup  imparts  its  bitterness 
to  water  for  years  even  if  used  every  day.  The  quantity  of  qnassin 


320  QUININE 

dissolved  at  each  dose  is  exceedingly  small,  or  the  cup  would  soon 
be  exhausted.  Yet  the  therapeutic  effects  are  undeniable;  and  in 
fact  seem  to  be  better  than  when  quassia  is  swallowed  without  being 
tasted.  The  effect  upon  the  gustatory  nerves,  if  not  the  principal 
one,  is  at  least  too  important  to  be  disregarded.  Give  the  smaller 
granules  of  quassin,  which  are  powerful  enough  for  all  ordinary 
cases,  and  let  each  dose  be  taken  in  solution  just  before  each  meal ; 
.and  you  will  secure  the  maximum  effect  with  the  minimum  of  the 
remedy. 

The  use  of  quassia  infusions  as  a  remedy  for  seat  worms  should 
be  discouraged.  There  are  more  efficient  methods  of  treatment, 
devoid  of  the  danger  sometimes  accruing  to  the  use  of  quassia. 

As  a  remedy  for  the  alcohol  habit  the  simple  bitters  are  less  ef- 
fective than  berberine,  which  more  powerfully  tonifies  the  relaxed 
fibers  and  removes  the  depression  and  nervelessness  of  the  reformed 
inebriate. 

QUININE. 

Standard  granules — Arsenate  gr.  1-67,  gm.  .001 ;  gr.  1-6,  gm.  .01 ;  hydro- 
bromate  gr.  1-6,  gm.  .01 ;  hydroferrocyanide  gr.  1-67,  gm.  .001 ;  hypophos- 
phite  gr.  1-6,  gm.  .01 ;  picrate  gr.  1-6,  gm.  .01 ;  salicylate  gr.  1-6,  gm.  .01 ; 
sulphate  gr.  1-6,  gm.  .01 ;  valerianate  gr.  1-6,  gm.  .01. 

Quinine  is  an  alkaloid  from  the  bark  of  various  species  of  Cin- 
chona. Closely  allied  bodies  are  found  in  Remijia,  and  in  other 
plants.  Cushny  enumerates  as  constituents  of  the  cinchonas  21  al- 
kaloids, 6  acids  and  3  neutral  bitter  substances.  The  effects  of  each 
specimen  of  the  bark  and  of  the  galenic  preparations  derived  from 
it,  consists  of  the  sum  of  the  effects  of  such  of  these  active  princi- 
ples as  it  possesses,  in  the  quantity  and  relative  proportions  in  which 
they  happen  to  exist  in  that  particular  specimen.  Those  principles 
which  have  been  studied  agree  as  to  their  general  effect  to  a  re- 
markable degree — in  fact  we  doubt  if  there  is  a  parallel  case  in  the 
known  vegetable  materia  medica,  where  all  the  active  principles  of 
a  plant  have  so  closely  similar  general  effects.  But  few  of  these 
active  principles  have  been  studied  or  even  tested ;  so  that  in  the 
numerous  agents  of  unknown  powers  there  may  be  as  absolute 
antagonism  as  exists  in  the  alkaloids  of  opium,  hyoscyamus  and 
jaborandi.  The  presence  of  three  varieties  of  tannic  acid  accounts 
for  the  astringency  of  cinchona  and  the  slowness  of  action  of  the 
crude  preparations.  Great  efforts  have  been  made  by  the  Indian 
government  to  push  the  use  of  a  preparation  consisting  of  the  com- 


QUININE  321 

bined  alkaloids  from  the  plant,  but  it  has  scarcely  been  heard  of  out- 
side that  country,  the  medical  profession  being  satisfied  with  the 
convenience,  certainty,  smallness  of  dose,  quick  action,  palatability, 
and  other  advantages  which  quinine  possesses  over  the  bark  from 
which  it  is  derived.  That  the  thought  of  obtaining  similar  ad- 
vantages from  the  use  of  the  alkaloids  of  other  plants  comes  so 
slowly  to  the  mind  of  the  profession  must  be  set  down  to  the  intense 
conservatism  characterizing  it. 

Physiologic  Action. — Quinine  first  stimulates,  then  kills  proto- 
plasm. Binz  found  that  minute  doses  may  increase  the  movements 
of  amoeba  and  infusoria,  at  first;  larger  doses  paralyze  them  at 
once,  the  protoplasm  becoming  dark  and  granular.  On  the  germs 
of  putrefaction  the  effect  is  about  equal  to  that  of  carbolic  acid. 
Alcoholic,  lactic  and  butyric  acid  fermentations  are  retarded  or  pre- 
vented by  quinine.  Moulds,  however,  grow  freely  in  its  solutions. 
Experimenting  with  the  sea-urchin,  Hertwig  found  that  quinine 
paralzyed  the  movements  of  its  spermatozoa,  and  delayed  or  pre- 
vented the  evolution  of  the  ovum.  Minute  quantities  of  quinine  suf- 
fice to  stop  the  movements  of  the  leucocytes,  prevent  their  passim? 
through  the  vessel  walls,  causing  them  to  become  darker,  granular, 
and  to  break  up  into  debris  (Binz).  No  accumulation  of  leucocytes 
at  an  irritated  point  occurs  under  quinine,  and  if  this  has  preceded 
the  application  of  quinine,  the  process  is  at  once  arrested  by  it.  The 
same  result  follows  when  quinine  is  carried  to  the  part  by  the  blood 
vessels.  Ordinary  doses  of  quinine  lessen  the  number  of  leucocytes 
in  the  blood. 

The  oxidizing  action  of  blood  is  diminished  by  quinine.  So  is 
its  coagulability.  The  gastric  and  pancreatic  ferments  are  rendered 
less  active  by  quinine  (Rossbach),  but  ptyalin  and  diastase  are  un- 
affected (Binz).  Quinine  prevents  the  formation  of  hippuric  acid 
from  ben  zoic  acid  and  glycocoll.  The  functions  of  the  spinal 
centers,  respiration,  circulation  and  vascular  pressure,  are  all  stim- 
ulated by  small  doses  of  quinine  and  sedated  by  very  large  ones. 
The  arterioles  are  contracted,  the  heart  accelerated,  both  actions  be- 
ing reversed  later  by  large  doses.  The  same  preliminary  stimula- 
tion and  subsequent  depression  is  noted  as  to  the  muscular  fiber. 
The  urine  is  slightly  increased. 

Given  to  man  in  medicinal  doses,  quinine  acts  on  the  stomach  as 
the  other  bitters  do,  increasing  the  appetite.  Full  doses  cause  ring- 
ing in  ears  and  some  deafness;  total  and  permanent  deafness  has 
followed  a  single  dose  of  40  grains  but  this  is  exceptional.  The 


322  QUININE 

field  of  vision  may  be  contracted,  and  partial  or  total  blindness  may 
ensue,  for  days  or  weeks. 

Color  vision  is  often  affected.  The  aural  disturbance  is  at- 
tributed to  congestion  of  the  auditory  apparatus,  that  of  sight  to 
contraction  of  the  retinal  vessels,  which  may  be  followed  by  some 
optic  nerve  atrophy.  Large  doses  cause  a  sense  of  fullness  in  the 
head,  slow  pulse  and  staggering.  In  the  few  cases  in  which  over^ 
doses  have  proved  fatal,  there  were  symptoms  of  heart  weakness 
and  collapse,  loss  of  sight  and  hearing,  muscular  weakness,  apathy, 
slow  gasping  respiration,  and  coma  with  failure  of  respiration. 
Delirium  and  convulsions  have  been  reported.  The  toxic  dose  is  un- 
certain, since  an  ounce  has  been  taken  without  dangerous  symptoms. 
Idiosyncrasies  are  not  rare.  The  aural  and  ocular  symptoms  de- 
scribed occasionally  follow  the  use  of  small  doses;  many  varieties 
of  eruptions  have  been  attributed  to  quinine ;  and  a  fever  resembling 
malaria.  Sometimes  it  contracts  the  uterus  and  may  cause  abortion, 
though  as  a  rule  no  such  effect  follows  the  use  of  even  full  doses. 
It  often  irritates  the  stomach,  even  in  moderate  doses — as  all  the 
bitters  are  liable  to  do — and  may  cause  diarrhea,  albuminuria  or 
hematuria.  The  writer  had  one  patient  in  whom  the  taking  of  four 
grains  of  quinine  repeatedly  caused  purpura  hemorrhagica. 

Even  in  doses  too  small  to  cause  any  tangible  symptoms,  quinine 
affects  metabolism.  The  destruction  of  nitrogenous  tissues  is 
markedly  lessened;  the  production  of  urea  and  uric  acid  being  es- 
pecially restricted;  the  excretion  of  phosphates  and  sulphates  is 
also  reduced,  but  the  excretion  of  carbonic  acid  and  absorption  of 
oxygen  through  the  lungs  is  not  materially  altered.  Cushny  con- 
cludes from  this  that  the  work  done  and  the  heat  formed  are  not 
affected  but  that  the  death,  growth  and  repair  of  the  tissues  are  less 
active.  Nitrogen  is  stored  in  the  body. 

In  malarial  and  other  fevers  quinine  lowers  the  temperature  by 
direct  action  on  the  tissues  (Binz).  It  has  little  effect  on  a  normal 
temperature.  Gottlieb  found  both  the  production  and  the  radiation 
of  heat  reduced  by  quinine.  The  reduction  of  temperature  is  much 
greater  if  given  when  the  fever  is  falling,  than  when  rising. 

Quinine  appears  in  the  urine  within  30  minutes  from  its  ad- 
ministration by  the  mouth,  and  one-half  the  whole  dose  is  excreted 
within  six  hours  (Cushny).  Traces  are  still  to  be  found  72  hours 
after  it  has  been  taken. 

Solutions  of  a  grain  to  the  ounce  destroy  microorganisms,  and 
double  this  strength  prevents  fermentation  and  putrefaction.  Large 


QUININE  323 

doses  destroy  the  sense  of  hunger  and  arrest  the  secretion  of  gastric 
juice.  It  has  been  detected  in  the  sweat,  tears,  and  milk  of  nurses; 
in  bile  and  the  fluid  of  dropsical  effusions.  Inflammatory  degenera- 
tion of  tissue  is  notably  decreased.  It  probably  destroys  infectious 
microorganisms  in  the  blood  and  tissues  (Shoemaker).  It  is  also 
found  in  the  feces. 

The  sulphate  of  quinine  is  soluble  in  800  parts  of  water,  the  hy- 
drochlorate  in  35,  the  hydrobromate  in  54,  and  the  valerianate  in 
100.  The  bisulphate  is  soluble  in  10  parts  of  water.  The  addition 
of  sulphuric,  hydrochloric,  hydrobromic,  or  any  acid,  renders  the 
sulphate  more  soluble,  but  increases  the  bitterness  of  the  solution. 
Quinine  is  absorbed  from  the  rectum,  the  vagina,  or  the  subcutane- 
ous tissue,  though  the  latter  is  a  very  painful  method  of  administra- 
tion and  apt  to  be  followed  by  abscess. 

Piorry,  Paget,  Magendie,  Landois  and  Mosler  affirm  that  quinine 
reduces  the  size  of  the  spleen  even  in  health,  as  it  undoubtedly  does 
in  malarial  affections,  but  Cushny  finds  the  evidence  inconclusive. 

By  many  quinine  is  credited  with  the  power  of  checking  the  exu- 
dation of  fibrin,  and  for  this  reason  it  is  administered  in  full  doses 
to  prevent  the  exudations  of  croup  and  pneumonia. 

Synergists. — As  an  antizymotic,  quinine  is  aided  by  arsenic, 
salicylic  acid,  resorcin,  the  sulphocarbolates ;  as  an  antipyretic  it  is 
associated  with  aconitine,  veratrine,  digitalin  and  the  coal  tar  group ; 
the  strychnine  group  increases  its  tonic  and  febrifuge  effects,  while 
as  a  means  of  delaying  or  preventing  nitrogenous  waste  it  is  aided 
by  caffeine  and  alcohol. 

Incompatibles.— Tannic  acid,  iodine  and  its  salts,  alkalies  and 
their  carbonates,  the  alkaline  earths,  all  precipitate  quinine  from 
solution. 

Therapeutics. — The  first  use  of  quinine  is  as  a  remedy  in 
malarial  fevers.  Here  its  great  value  has  led  to  abuse  and  incredible 
carelessness  in  its  administration,  so  that  a  series  of  reactions 
against  it  occur. 

In  all  cases  when  time  is  allowed  it  is  best  to  thoroughly  empty 
the  alimentary  canal  by  efficient  cathartics,  and  disinfect  with  a 
sufficiency  of  the  sulphocarbolates.  Then  give  quinine  in  full  doses, 
during  the  decline  of  the  fever.  In  intermittents  from  10  to  15 
grains  a  day  suffice  for  an  adult ;  in  remittents  these  doses  should 
be  doubled;  while  in  the  pernicious  forms  of  malaria  met  in  the 
tropics  forty  to  sixty  grains  should  be  given  without  delay.  It  is 
best  to  use  the  soluble  salts,  as  much  of  the  large  doses  of  the  sul- 


324  QUININE 

phate  is  ejected  unabsorbed.  In  the  algid  forms,  or  pernicious 
chills,  the  dose  should  be  injected  hypodermically  or  by  the  rectum, 
in  solution.  Inunctions  of  quinine  are  too  uncertain  for  dependence. 
The  bimuriate  of  quinine  and  urea  is  quite  soluble,  but  the  hydro- 
chlorate  answers  about  as  well. 

It  has  been  claimed  that  the  arsenate  of  quinine  fully  represents 
the  virtues  of  this  agent,  and  that  a  grain  equals  in  therapeutic  ef- 
fect fifteen  grains  of  the  sulphate.  This  is  still  undecided,  but  there 
is  reason  to  believe  that  it  is  true.  At  least  the  efficacy  of  the 
arsenate  in  the  chronic  forms  of  malarial  toxemia  appears  to  be 
much  greater  than  that  of  the  sulphate,  in  any  dose.  It  is  hardly 
possible  to  overestimate  the  importance  of  the  preliminary  cleansing 
and  disinfection  of  the  gastrointestinal  tract. 

Many  prefer  to  administer  the  antipyretic  dose  of  quinine  in  a 
single  dose,  aiming  to  so  give  it  that  the  ringing  of  the  ears  may 
occur  at  or  just  before  the  expected  recurrence  of  the  chill — that 
is,  about  six  hours  before  the  latter  is  due.  But  the  writer  believes 
any  advantage  derived  is  suggestive,  and  malaria  has  always  been 
known  to  be  amenable  to  suggestion.  Better  results  may  be  ob- 
tained with  much  smaller  doses  by  giving  the  quinine  in  very  small 
doses  very  frequently  repeated,  so  that  there  is  never  a  moment  when 
the  remedy  is  absent  from  the  blood  and  the  alimentary  canal. 

No  matter  how  large  a  dose  of  quinine  may  be  given,  it  will  not 
prevent  the  multiplication  and  continued  action  of  the  parasites 
after  the  effects  of  the  dose  have  subsided;  but  if  there  is  a  con- 
tinual infiltration  of  the  drug  into  the  blood  there  is  never  a  moment 
but  that  the  newborn 'plasmodia  are  met  and  killed  by  it;  until  the 
invaders  have  become  extinct.  This  at  least  illustrates  the  method 
of  treating  the  disease  that  has  proved  most  successful,  whether  the 
explanation  is  literally  correct  or  not. 

Van  Renterghem  advises  the  administration  of  a  massive  dose 
to  break  up  the  attack ;  meeting  the  fever  with  the  defervescents, 
following  with  the  selected  quinine  salt,  one  to  five  granules  every 
half-hour,  or  hourly,  adding  a  granule  or  two  of  strychnine  for 
adults  or  one  to  five  of  brucine  for  children.  This  is  continued  until 
the  next  period  for  a  chill  has  passed.  If  a  new  access  occurs 
strychnine  is  given  alone,  a  granule  or  two  every  half-hour  during 
the  cold  stage,  then  the  Defervescent  Triad  during  the  fever.  But 
the  second  chill  is  unlikely  to  happen,  the  third  still  more  so.  On  the 
free  days  one  should  take  the  arsenates  of  quinine  and  arsenic,  one 
to  three  granules  each,  every  two  or  three  hours.  This  dosage  is 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


QUININE  325 

not  absolute — the  physician  must  regulate  them  by  the  need  and  the 
effect.  Dosimetry  gives  a  choice  of  the  quinine  salts. 

In  malarial  dropsy  and  enlarged  spleen  he  employs  quinine  and 
such  other  agents  as  may  be  indicated — iron  for  anemia,  quassin  for 
anorexia  and  dyspepsia,  strychnine  for  general  systemic  atony, 
digitalin  for  dropsy,  quinine  and  arsenic  for  the  paludal  cachexia. 
Of  the  arsenates  of  strychnine,  iron,  quinine  and  soda,  give  five  to 
ten  granules  each  in  a  day ;  quassin  two  to  four  granules  before  each 
meal ;  digitalin  a  granule  or  two  hourly  or  half-hourly  till  the  urine 
is  secreted  abundantly. 

In  neuralgias  and  paroxysmal  neuroses  quinine  will  often  pre- 
vent the  attacks.  He  prefers  the  hydroferrocyanate,  valerianate  and 
arsenate  here;  given  half-hourly  or  hourly  in  the  intervals,  often 
adding  strychnine  arsenate.  During  the  attack  give  aconitine, 
caffeine,  morphine,  hyoscyamine,  strychnine,  gelseminine,  butyl- 
chloral,  zinc  cyanide,  alone  or  combined. 

For  non-paroxysmal  neuroses,  quinine  has  not  the  decided  bene- 
ficial action  shown  in  the  preceding  forms. 

As  an  antipyretic  quinine  has  been  largely  employed  in  many 
fevers,  typhoid,  eruptive,  pneumonia,  pyemia,  hectic  and  puerperal; 
alone  in  massive  doses  or  with  cold  baths.  Juergensen  gave  doses 
of  60  to  75  grains  in  pneumonia,  and  Pepper  gave  suppositories  of 
ten  to  twenty  grains  in  the  pneumonia  of  infants.  In  the  fever  of 
tubercular  phthisis  the  old  favorite  termed  Niemeyer's  pill  may  be 
represented  alkalometrically  by  a  grain  of  quinine  hydrochlorate, 
digitalin  gr.  1-67,  emetine  gr.  1-67,  and  codeine  gr.  1-12;  and  this 
may  be  given  every  four  hours.  But  the  cleansing  and  disinfection 
of  the  alimentary  canal  has  proved  more  effective,  with  the  Defer- 
vescent  Triad  or  the  Trinity  of  Burggraeve,  so  that  the  need  for 
quinine  is  rarely  met. 

In  acute  inflammations  of  all  sorts  Van  Renterghem  considers 
quinine  indicated  as  an  antiphlogistic.  He  advises  small  doses  re- 
peated so  often  that  the  solution  of  quinine  constantly  bathes  the 
affected  tissues.  He  has  also  employed  this  agent  with  success  in 
treating  hemorrhages,  bronchial,  pulmonary,  intestinal,  uterine; 
giving  fractional  doses  with  arsenic,  strychnine,  ergotin,  and  of  late 
with  hydrastine. 

As  a  general  tonic  quinine  has  been  altogether  replaced  by 
strychnine. 

Quinine  is  one  of  our  most  reliable  remedies  in  whooping- 
cough,  when  given  in  doses  of  three  or  four  grains  to  a  child  two 


326  QUININE 

years  old.  It  is  best  given  here  as  the  sulphate,  suspended  in  syrup 
of  yerba  santa,  which  covers  the  taste  admirably.  There  is  possibly 
some  local  action  on  the  throat  when  thus  given.  The  addition  of 
acid  to  render  the  quinine  soluble  ruins  this  mixture  by  precipitat- 
ing the  yerba  santa  as  a  tarry  mass. 

In  true  spasmodic  asthma  a  full  dose  of  quinine,  gr.  15,  given  at 
bedtime,  will  quite  surely  prevent  the  paroxysm  for  the  following 
night. 

As  quinine  lessens  the  production  of  uric  acid,  part  of  the  credit 
it  once  possessed  may  have  been  due  to  its  administration  in  uric- 
acidemia.  But  agents  promoting  the  elimination  of  this  toxin  are 
to  be  preferred. 

Quinine  has  been  advised  in  the  choleras,  presumably  as  an  anti- 
septic; but  there  are  many  better  and  less  irritant  agents  for  such 
uses. 

Shoemaker  says  quinine  favorably  influences  the  broncho-pneu- 
monia of  measles,  and  combats  the  tendency  to  caseous  degenera- 
tion; reduces  the  discharges  of  suppuration,  prevents  sapremia  and 
pyemia;  is  of  use  for  phthisical  night-sweats,  neurasthenia,  general 
debility;  Meniere's  disease  (Charcot)  ;  and  malarial  skin  diseases 
(Yandell). 

Haig  states  that  ordinary  sulphate  of  quinine  contains  20  per 
cent  of  xanthin,  equivalent  to  uric  acid,  and  this  may  aid  in  de- 
stroying red  blood  cells  and  liberating  hemoglobin,  producing 
hematuria  in  malaria. 

Quinine  was  for  many  years  employed  so  generally  that  it  was 
almost  a  matter  of  course  to  have  this  in  the  prescription ;  and  many 
tons  of  it  were  thus  wasted.  Its  place  in  this  respect  seems  to  have 
been  taken  by  strychnine. 

The  contraindications  for  quinine  are :  Idiosyncrasy,  acute  in- 
flammation of  the  genitourinary  tract,  kidneys,  stomach,  bowels,  or 
middle  ear  with  impaired  hearing,  infantile  eczema,  epilepsy. 

The  effect  of  quinine  upon  the  ears  is  largely  prevented  or  re- 
lieved by  giving  full  doses  of  any  bromide,  or  of  hydrobromic  acid. 
The  use  of  small  and  oft-repeated  doses  allows  the  physician  to  ad- 
minister this  drug  till  the  first  evidences  of  action  are  manifest  and 
then  stop  it  or  give  less  frequently;  by  which  all  such  unpleasant 
effects  are  prevented. 

Some  authors  credit  quinine  with  oxytocic  powers,  and  advise  it 
in  place  of  ergot  in  atonic  states  of  the  uterus.  This  would  render 
pregnancy  a  contraindication  to  its  use.  But  others  deny  this,  and 


RESORCIN.     RHEIN  327 

look  upon  such  an  action  as  rare,  and  an  idiosyncrasy.     In  dealing 
with  pregnant  women  it  is  well  to  keep  on  the  side  of  safety. 


RESORCIN. 

Standard  granule — Gr.  1-6,  gm.  .01. 

Resorcin  is  a  synthetic  product,  one  of  the  few  that  seems  worthy 
of  a  place  in  modern  therapeutics.  It  is  soluble  in  water,  alcohol  or 
glycerin.  Injected  subcutaneously  it  causes  little  inflammation  and 
no  suppuration.  In  doses  of  gr.  30  to  a  dram  it  acts  as  an  anti- 
pyretic, reducing  the  temperature  for  some  hours,  but  causing 
nausea  and  symptoms  of  marked  depression.  Larger  doses  are 
dangerous,  and  death  has  been  caused  in  children  by  washing  out 
the  stomach  with  a  3  per  cent  solution.  It  is  excreted  with  the 
urine,  and  has  caused  hemoglobinuria. 

The  symptoms  of  overdoses  call  for  stimulants,  hot  drinks, 
atropine  and  strychnine  hypodermically. 

Resorcin  is  antipyretic  in  the  doses  named,  but  has  been  super- 
seded by  safer  and  not  less  efficient  remedies  of  this  class.  It  is 
antiseptic,  but  the  sulphocarbolates  replace  it  as  well  and  more 
safely.  It  is  antirheumatic,  and  in  cases  with  evident  gastric  fer- 
mentation and  high  fever  resorcin  may  be  well  suited,  especially 
when  the  salicylates  are  not  well  borne.  Here  it  is  best  to  give  the 
small  dose,  gr.  1-6,  every  quarter  or  half-hour,  till  improvement  is 
decided.  Resorcin  is  also  astringent,  and  possibly  in  the  declining 
stages  of  cholera  infantum  and  other  gastrointestinal  maladies  it 
may  be  appropriate ;  though  the  sulphocarbolate  of  zinc  leaves  little 
to  be  desired  in  this  respect.  In  fermentative  dyspepsia  resorcin 
is  useful,  given  as  recommended  for  rheumatism. 

Locally  resorcin  has  been  extensively  employed  as  an  antiseptic 
and  astringent,  and  with  benefit.  The  applications  are  too  numerous 
and  too  obvious  to  require  enumeration. 

» 

RHEIN. 

Standard  granule — Gr.  1-6,  gm.  .01. 

Rhein  is  a  concentration  from  rhubarb,  the  root  of  Rheum  of- 
ficinale. 

Rhubarb  contains  a  glucoside  chrysophan,  besides  emodin, 
chrysophanic  acid,  phaeoretin,  erythrorhetin,  aporhetin,  rheotannic 
and  rheumic  acids,  and  certain  resins.  Dragendorff  attributed  the 


328  RHEIN 

purgative  principle  to  the  cathartic  acid,  while  the  astringent  tonic 
action  is  due  to  the  tannic  acids,  the  antiseptic  effect  to  chrysophanic 
acid  and  emodin.  Hesse  also  obtained  a  crystallizable  principle, 
rhein,  but  Tschirch  attributes  the  purgative  power  to  emodin,  or 
chrysophan.  However,  the  true  values  of  rhubarb  cannot  be  said  to 
depend  on  any  one  of  its  constituents,  as  at  present  known,  but  upon 
their  combination ;  and  although  forming  an  exception  to  the  alka- 
loidal  principle,  we  must  content  ourselves  with  the  concentration 
until  chemistry  has  advanced  our  knowledge.  Yet  it  is  one  of  the 
remedies  that  fills  a  valuable  need,  and  cannot  be  replaced  by  any 
one  of  the  modern  remedies,  though  they  have  materially  narrowed 
its  field. 

Therapeutics, — Rhubarb  increases  the  saliva,  gastric  and  intes- 
tinal juices  and  stimulates  peristalsis ;  later  its  astringent  principles 
exert  their  influence.  This  renders  rhubarb  especially  suitable  to  the 
treatment  of  diarrheas  where  it  is  necessary  to  clear  the  gastro- 
intestinal tract  of  offending  matter  and  check  the  discharges  later. 
In  children  especially  this  indication  frequently  presents  itself. 
Rhubarb  increases  the  secretion  of  bile,  though  not  a  powerful 
cholagog.  In  fact,  it  has  the  repute  of  stimulating  the  healthy, 
normal  secretions  instead  of  pathologic  ones.  The  coloring  matters 
are  excreted  through  the  kidneys  and  the  renal  excretion  is  in- 
creased. The  purgative  resins  are  excreted  by  the  liver,  intestinal 
glands,  kidneys  and  skin.  The  nurse's  milk  contains  enough  to 
purge  her  nursling. 

Rhubarb  is  used  largely  for  the  gastric  and  intestinal  troubles 
of  children  due  to  improper  diet,  to  cold,  over-eating,  and  emotion. 
When  the  child  is  cross  and  fretful  this  remedy  usually  restores 
peace  and  happiness  to  the  household. 

It  is  also  an  effective  remedy  for  colics  dependent  on  undigested 
food  or  other  irritating  matter  in  the  stomach  or  bowels.  Travelers' 
diarrheas  from  change  of  water,  of  adults  or  children ;  sea  and  car 
sickness,  acidity  with  irritating  discharges,  and  hemorrhoids,  es- 
pecially during  or  after  pregnancy,  are  benefited  by  rhubarb.  For 
gastric  catarrh  the  best  way  to  use  it  is  to  take  one  of  the  granules 
as  a  lozenge,  dissolved  in  the  mouth,  every  one  to  three  hours. 

In  the  early  and  mild  forms  of  summer  diarrhea  and  cholera  in- 
fantum,  rhubarb  is  most  effective.  Here  it  may  be  given  with 
emetine,  hydrastine  and  menthol,  a  granule  of  each  every  two  hours 
till  the  stools  passed  are  natural  in  appearance.  Zinc  or  soda  sul- 
phocarbolate  should  be  added  if  the  stools  are  offensive.  In 


RHUS   TOX  329 

cachectic,  rickety  children  the  sulphocarbolate  of  calcium  with  the 
above  combination  is  excellent. 

Felter  and  Lloyd  give  as  the  specific  indications  for  rhubarb: 
Gastric  irritation,  nausea,  vomiting,  elongated  tongue  red  at  tip  and 
edges;  irritative  diarrhea  with  soreness  on  pressure;  sour  smelling 
discharges  imparting  a  sour  odor  to  the  child ;  gastrointestinal  irrita- 
tion with  nervous  irritability,  restlessness,  screaming  and  con- 
vulsive muscular  contractions;  constipation  with  a  sense  of  in- 
testinal constriction  and  abdominal  contraction;  light-colored  fecal 
discharges. 

Rhubarb  seems  unknown  to  the  French  Dosimetrists,  who  have 
utilized  juglandin  largely  as  a  substitute— and  the  writer  has  found 
the  latter  so  satisfactory  that  he  does  not  use  rhubarb  one-tenth  as 
much  as  he  did  before  he  learned  to  use  juglandin. 

The  dose  of  rhein  for  a  child  of  two  years  is  a  granule  every  two 
hours  till  the  stools  are  normal.  For  adults  two  to  five  granules 
may  be  given  at  the  same  intervals. 

RHUS    TOX. 

Standard  granule — M.  i-io. 

The  granules  of  rhus  tox.  are  prepared  from  the  green  leaf 
tincture. 

The  effects  of  rhus  are  due  to  a  neutral  body,  toxicodendrol, 
closely  resembling  cantharidin,  anemonin  and  euphorbol  (Pfaff). 
It  is  not  volatile  and  the  belief  in  poisoning  from  this  plant  without 
actual  contact  is  said  by  Cushny  to  be  without  foundation.  Tox- 
icodendrol is  a  fixed  oil,  soluble  in  alcohol  but  not  in  water,  rendered 
insoluble  by  lead.  Maisch  claimed  that  the  true  active  principle  was 
toxicodendric  acid,  a  volatile  principle,  and  that  the  exhalations  of 
vigorous  leaves  redden  blue  litmus,  if  previously  dampened. 

Felter  and  Lloyd  say  that  rhus  is  a  powerful  local  irritant,  af- 
fecting persons  with  varying  degrees  of  virulence,  and  that  many 
persons  are  poisoned  without  actual  contact,  especially  if  the  air  is 
heavy  and  humid  or  the  patient  perspiring.  Alcoholic  solutions  retain 
the  virulence  for  years  (Johnson).  A  lady  in  Lloyd's  employ  is  not 
allowed  in  the  building  when  rhus  is  being  bottled,  so  intense  are 
the  symptoms  produced  by  the  emanations.  The  symptoms  tend 
to  recur  monthly  or  yearly  in  some  persons  once  poisoned  by  this 
plant.  Horses,  cows  and  sheep  are  unaffected  by  eating  the  leaves, 
but  dogs  and  guinea  pi^s  are  killed  by  it.  Drying  or  heating  dis- 
sipates the  toxic  properties,  at  least  in  part. 


330  RHUS   TOX 

The  local  effects  consist  of  a  dermatitis  with  itching  and  swell- 
ing, redness  and  sometimes  vesicles,  burning  pain  and  fever.  Some- 
times pus  forms.  Headache  and  even  delirium  may  be'  present  in 
severe  cases.  The  symptoms  appear  some  hours  after  contact  and 
the  affection  runs  its  course  within  a  week.  The  skin  desquamates. 

Given  internally,  rhus  acts  on  the  kidneys  and  skin,  slightly  on 
the  bowels.  For  paralyses  it  should  be  cautiously  pushed  until  it 
causes  prickling  and  burning,  with  twitching  of  the  paralyzed  parts, 
when  improvement  of  sensation  and  motion  will  be  manifest.  Large 
doses  cause  vertigo,  dilation  of  the  pupils,  impairment  of  the  special 
senses,  chilliness,  nausea,  tliirst,  burning  in  the  stomach,  temporal 
constriction,  pulse  slow,  irregular  and  weak,  urine  and  perspiration 
increase,  weakness,  trembling  and  faintness  occur,  sometimes  con- 
vulsions, and  a  state  of  stupor  or  coma  may  supervene. 

Felter  and  Lloyd  vaunt  rhus  highly,  saying  its  range  of  applica- 
tion is  exceeded  by  few  drugs.  It  is  an  ideal  sedative,  controlling 
the  circulation  and  acting  strongly  on  the  nervous  system.  The 
specific  indications  are :  The  small,  moderately  quick,  vibratile 
pulse,  with  sharp  stroke,  and  burning  sensations ;  nervous  erethism ; 
the  sick  infant  sleeps  disturbedly,  frequently  starting  suddenly,  with 
cri  encephalique,  often  seen  in  cholera  infantum  and  cerebrospinal 
meningitis.  The  circulatory  disturbance  requiring  rhus  is  localized, 
in  small  cerebral  or  nerve  centers.  Restlessness  is  great  in  propor- 
tion. Frontal  and  left  orbital  pain,  sharp;  tongue  red  at  tip  and 
edges  or  strawberry  with  tympanites,  brown  sordes,  red  mucosa, 
acrid  discharges,  ichorous  flow,  disappearing  by  drainage.  It  re- 
lieves vomiting  when  with  the  tongue  described.  Great  unrest  with 
vomiting  is  a  chief  indication  for  rhus.  Burning  pain,  deep  or 
superficial  is  relieved  by  rhus  quicker  than  by  any  other  agent ; 
whether  of  the  head,  abdominal,  thoracic  or  urinary  organs,  eyes  or 
skin.  It  may  be  neuralgic,  rheumatic,  pleuritic,  cystitic,  etc.  Burn- 
ing and  erysipelatous  redness  of  the  skin  rhus  cures.  It  relieves 
rheumatic  pain  made  worse  by  the  warmth  of  the  bed.  It  is  better 
in  acute  than  in  chronic  rheumatism,  and  in  the  articular  stiffness 
following  attacks.  It  controls  the  restlessness  of  rheumatics.  Tooth- 
ache aggravated  by  heat  it  relieves.  It  is  of  value  in  bowel  troubles 
of  infants,  diarrhea,  typhoid  dysentery,  typhoid  and  malarial  fevers 
with  typhoid  symptoms,  and  in  cholera  morbus.  It  is  valuable  in 
pneumonia,  bronchitis,  influenza  and  phthisis,  when  the  patient  is 
extremely  irritable  and  the  stomach  irritated.  With  the  small  wiry 
pulse  as  a  guide  it  controls  restlessness  and  delirium  in  adynamic 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


RHUS   TOX  331 

fevers ;  is  indicated  in  typhoid  pneumonias  with  red  glazed  tongue 
and  fetid  sputa ;  relieves  dry  tickling  cough ;  and  skin  diseases  with 
redness,  swelling  and  burning.  It  is  excellent  for  vivid  bright  red 
erysipelas,  facial,  with  puffiness ;  acute  dermatites ;  herpes  with  burn- 
ing, itching  and  exudation;  with  iron  in  purpura  hemorrhagica ; 
vulvar  erythema  and  erysipelas,  with  burning,  and  itching  irritation 
following  micturition;  a  special  antizymotic  in  the  exanthemata  and 
all  zymotic  diseases;  with  vital  depression,  livid  skin  and  foul  dis- 
charges ;  red  glistening  swellings  or  edges  of  ulcers ;  parotitis,  sub- 
maxillary  swellings;  carbuncle,  furuncle;  ocular  swellings,  to  pre- 
vent inflammation  after  cataract  operations,  papebral  cedema  with 
redness,  pains  in  the  eye  globe,  conjunctivitis  acute  or  chronic,  catar- 
rhal  ophthalmia  of  scrofulous  children  with  inflamed  lids,  photo- 
phobia, etc. ;  paraplegia  without  any  organic  lesion ;  paralysis  of  the 
bladder  and  rectum.  But  it  is  of  little  value  in  any  paralyses  save 
those  following  rheumatism.  In  sciatica  it  is  efficient. 

Specific  Indications.— Small,  moderately  quick,  sharp  pulse, 
sometimes  vibratile  or  wiry;  great  restlessness;  with  vomiting; 
tongue  red  and  irritable,  red  spots,  strawberry  tip;  burning  pain; 
pain  in  or  above  left  orbit ;  pinched  face ;  burning  urethral  pain,  with 
dribbling,  etc. 

Ellingwood  recommends  rhus  in  acute  rheumatism,  with  aconite 
for  fever,  cimicifuga  for  deep-seated  muscular  soreness;  in  dry 
tickling  bronchial  coughs,  with  bryonia  or  aconite  in  capillary 
bronchitis;  gastric  or  intestinal  disorders  of  children  with  great 
restlessness  and  flushed  face;  and  the  specific  tongue,  mouth  and 
mucous  indications;  prevents  spasms  from  cerebral  engorgement  or 
reflex,  or  from  gastric  or  intestinal  irritation.  He  finds  it  most 
prompt  and  valuable  in  pruritus  vulvae  with  erythema,  redness,  es- 
pecially in  blonde  children  with  eczematous  or  scrofulous  tendencies^ 
Dr.  R.  E.  Buchanan  reports  excellent  results  from  rhus  in  lum- 
bago, acute  muscular  soreness,  torticollis,  and  similar  myalgic 
troubles. 

Dr.  John  Aulde  is  one  of  the  few  who  have  studied  this  remedy. 
He  finds  the  first  effects  of  remedial  doses  to  be  stimulant  to  the 
cerebral  functions,  differing  with  the  great  disparity  in  its  effects  in 
various  individuals.  The  effects  upon  the  skin  are  due  to  the  en- 
deavor of  the  epidermic  cells  to  drive  out  the  intruder.  This  renders 
this  agent  suitable  in  affections  showing  sluggish  skin-action,  or  inac- 
tivity of  the  cellular  structures.  He  recommends  rhus  in  scaly  skin 


332  RHUS   TOX 

diseases,  subacute  and  chronic  rheumatism,,  and  as  a  quick  means 
of  relieving  the  pain  of  rheumatic  gout. 

Dr.  A.  T.  Cuzner  testifies  to  the  efficiency  of  rhus  in  rheumatism. 

Dr.  C.  W.  Smiley  writes  that  while  suffering  from  nervous  de- 
bility and  general  prostration,  insomnia  and  great  irritability,  he  was 
attacked  by  rhus  poisoning  after  free  exposure  to  the  weed.  Soon 
after  he  found  his  health  had  undergone  a  remarkable  change  for 
the  better,  and  he  was  soon  boasting  of  complete  recovery.  He  at- 
tributes the  result  to  the  free  elimination  of  toxins,  caused  by  the 
rhus. 

Dr.  J.  M.  Blackerby  found  rhus  successful  in  sciatica;  facial 
erysipelas ;  synovitis  of  both  knees,  subinflammatory,  tongue  red  and 
pointed,  bowels  acting  naturally,  urine  scanty,  red  and  offensive, 
pulse  108,  temp.  101.5,  heart  feeble — patient  a  man  aged  2.2. 

In  The  Alkaloidal  Clinic  some  years  ago  the  subject  of  rhus 
poisoning  was  discussed  at  length,  and  many  physicians  suggested 
remedies  for  it.  Of  these  the  local  application  of  sweet  spirit  of 
niter  seemed  to  have  the  most  decided  and  prompt  effect  in  relieving 
the  symptoms  and  curing  the  malady.  Webster  reports  one  patient 
treated  by  echinacea  locally  and  internally,  who  was  not  only  cured 
but  henceforth  proved  immune  against  the  poison.  Among  other 
remedies  named  were  alnus,  apocynin,  hydrogen  peroxide,  pilo- 
carpine  hypodermic,  sodium  bicarbonate  locally,  aristol,  lobelia 
locally,  lead  and  laudanum,  white  oak  bark  infusion,  quinine  oint- 
ment one  to  8,  sodium  bisulphite  5  per  cent  solution  with  one  per 
cent  of  carbolic  acid,  dilute  alcohol  saturated  with  lead  acetate  and 
well  rubbed  into  the  skin,  zinc  sulphate  one  to  15  of  water,  ham- 
amelis,  serpentaria,  sodium  hyposulphite  saturated  solution,  and 
numerous  others. 

Some  persons  appear  to  be  immune  against  the  effects  of  rhus, 
and  they  are  said  to  be  also  immune  against  its  remedial  operation. 
The  more  susceptible  the  patient,  the  more  certain  is  rhus  to  cure  his 
maladies  when  correctly  prescribed. 

In  administering  rhus  it  is  best  to  give  the  granules  containing 
but  a  fraction  of  a  drop,  and  repeat  them  every  half-hour  until 
tangible  effects  are  manifest.  This  avoids  the  painful  rhus  toxica- 
tion  in  persons  unusually  liable  to  it,  and  ensures  action  in  those 
difficult  to  affect  by  it. 


SALICIX.     SALICYLIC  ACID  333 

RUMICIN. 

Standard  granule — Gr.   1-6,  gm.  .01. 

Rumicin  is  a  concentration  from  Rumex  crispus,  the  yellow  dock. 

Rumex  contains  chrysophanic  and  oxalic  acids. 

Felter  and  Lloyd  pronounce  rumex  decidedly  alterative,  tonic, 
mildly  astringent  and  detergent.  They  recommend  it  in  scorbutic, 
cutaneous,  scrofulous,  scirrhous  and  syphilitic  affections,  leprosy 
and  elephantiasis ;  finding  the  plant  inducing  retrograde  metamor- 
phosis, increasing  innervation  and  improving  nutrition ;  in  bad  blood 
with  skin  disorders,  chronic  lymphatic  enlargements,  with  tendency 
to  indolent  ulcerations  and  low  inflammatory  deposits ;  small  doses 
in  nervous  dyspepsia  with  epigastric  fullness  and  pain,  aching  or 
darting  pain  in  the  left  chest,  gastric  flatulence  and  eructations ; 
for  painless  watery  diarrhea ;  cough  with  fullness  of  chest,  sighing, 
yawning,  efforts  for  full  inspiration ;  best  in  lung  ails  with  bad 
blood ;  respiratory  catarrhs  and  sore  throat  with  hypersecretion,  and 
even  in  incipient  phthisis;  dry  stubborn  summer  coughs  (Webster)  ; 
internally  for  contagious  prurigo. 

Specific  Indications. — Bad  blood  with  chronic  skin  diseases; 
bubonic  swellings ;  low  deposits  in  glands  and  cellular  tissues,  tend- 
ency to  indolent  ulceration ;  feeble  recuperative  power ;  irritative,  dry 
laryngotracheal  cough ;  stubborn,  dry  summer  cough ;  chronic  sore 
throat  with  enlarged  glands  and  hypersecretion ;  nervous  dyspepsia 
with  epigastric  fullness  and  left  thorax  pain ;  cough  with  dyspnea 
and  precordial  fullness. 

Ellingwood  values  rumex  as  a  renal  depurant  and  agent  to  re- 
move morbific  matters  from  the  body;  for  ulcerative  stomatitis, 
nursing  sore  mouth,  gastric  ulcer  with  atony,  it  has  no  equal.  It  has 
cured  obstinate  morning  diarrheas. 

Rumicin  seems  to  be  best  administered  in  doses  of  one  to  six 
granules  for  an  adult,  before  meals  and  at  bedtime.  Give  for  several 
weeks  or  longer — it  is  not  a  remedy  for  immediate  effect.  It  would 
be  a  good  adjuvant  to  arsenic  iodide. 

SALICIN.     SALICYLIC    ACID. 

Standard  granule— Gr.  1-6,  gm.  .01. 

Salicin  is  a  glucoside  from  Salix  nigra,  found  in  many  species  of 
willow  and  poplar.  It  is  decomposed  and  oxidized  into  salicylic  acid 
in  the  alimentary  canal,  and  exerts  the  effects  of  this  acid  in  the  body. 


334  SALICIN.     SALICYLIC  ACID 

It  is  excreted  through    the    urine.      Salicin  is  less  irritant    to   the 
stomach  than  the  acid. 

Salicylic  acid  and  its  congeners  are  as  antiseptic  as  carbolic  acid 
but  far  less  toxic.  The  salicylates  are  also  much  less  irritant  than 
the  acid.  It  retards  digestion,  affecting  every  one  of  the  ferments 
injuriously.  It  also  retards  the  putrefaction  of  proteids  and  the 
alcoholic  and  acetous  ferments.  Its  effects  in  this  respect  are  less 
powerful  than  those  of  carbolic  acid  but  last  longer.  The  motion  of 
protoplasm,  protozoa  and  leucocytes  is  prevented  by  the  acid. 

Salicylic  acid  and  its  salts  are  quickly  absorbed,  and  give  rise  to 
unpleasant  symptoms  only  when  given  in  large  doses.  They  cause  a 
sense  of  heaviness  and  fullness  in  the  head,  roaring  in  the  ears  like 
that  of  quinine,  followed  by  confusion  and  dullness,  with  disorder 
of  sight.  Free  sweating  and  a  sense  of  heat  may  occur.  Dyspnea 
has  been  noted,  with  evidences  of  collapse.  The  pulse  is  weak,  the 
temperature  subnormal,  and  partial  or  complete  unconsciousness 
may  follow.  In  some  cases  delirium,  hallucinations  of  sight  and 
hearing,  have  been  noted,  especially  in  alcoholics  and  diabetics.  Al- 
buminuria  and  hemoglobinuria  have  also  occurred.  Skin  eruptions 
are  more  common  from  its  long  continued  use  than  from  too  large 
doses.  Abortion  occurs  sufficiently  often  to  render  pregnancy  a  con- 
traindication. Hemorrhages  may  appear,  especially  from  the  nose. 

But  to  all  the  foregoing  there  is  to  be  added  the  following :  Hare 
collected  a  large  number  of  cases  of  poisoning  by  these  agents,  show- 
ing that  in  some  so  small  a  dose  as  15  grains  caused  toxic  symptoms, 
while  in  others  two  ounces  were  swallowed  without  causing  death. 
It  seems  quite  certain  that  the  commercial  synthetic  acid  and  its  salts 
are  contaminated  by  impurities  to  which  most  of  the  toxic  symptoms 
are  really  due;  while  the  chemically  pure  acid  and  its  salts  do  not 
irritate  the  stomach  or  depress  the  heart  in  any  doses  likely  to  be 
given  medicinally. 

The  affections  of  hearing  are  due  to  congestion,  even  extending 
to  inflammation ;  they  rarely  leave  permanent  diminution  of  hearing ; 
the  dimness  or  loss  of  sight  is  due  to  vascular  constriction  possibly ; 
the  cutaneous  vessels  are  dilated,  the  pressure  increased  by  small 
doses,  lowered  by  large  ones ;  small  doses  accelerate  the  heart,  large 
ones  slow  it,  from  direct  action  on  the  heart ;  the  respiration  is  faster 
from  central  action,  the  center  being  depressed  and  paralyzed  later, 
from  which  death  ensues. 

The  effect  on  the  central  nervous  system  is  slight.  Sweating  is 
due  to  dilation  of  the  cutaneous  vessels,  which  may  explain  the 


SALICIN.    SALICYLIC  ACID  335 

rashes.  The  urine  is  increased,  as  is  the  production  of  urea,  the 
bile  solids  but  not  the  fluid.  The  normal  temperature  is  only  low- 
ered by  toxic  doses.  Fever  heat  it  often  lowers.  The  fall  is  due  to 
dilation  of  the  skin  vessels  and  to  an  increased  radiation ;  it  is  less 
and  of  shorter  duration  than  the  fall  caused  by  antipyrin. 

Salicylic  acid  modifies  metabolism,  increasing  the  nitrogen  and 
sulphur  eliminated  by  the  kidneys  by  over  10  per  cent.  The  excre- 
tion of  uric  acid  is  increased  from  30  to  100  per  cent.  The  leuco- 
cytes increase  in  number.  Mainly  excreted  in  the  urine,  salicylic 
acid  is  found  in  the  milk,  perspiration  and  bile,  but  not  in  the  gastric 
juice. 

The  use  of  this  acid  as  a  preservative  of  foods  and  beverages  is 
now  forbidden  by  the  laws  of  many  countries.  The  effects  upon  the 
digestive  ferments  justify  such  legislation;  and  besides  the  use  of 
such  preservatives  enables  the  unscrupulous  packer  to  utilize 
products  in  which  decomposition  has  already  progressed  beyond  the 
point  of  wholesomeness. 

Van  den  Corput  states  that  salicylic  acid  lessens  the  functional 
activity  of  the  testes,  and  Salix  nigra  has  long  had  the  reputation  of 
suspending  the  sexual  powers.  Yet  the  same  agent  is  believed  to 
congest  the  uterus  and  ovaries. 

Therapeutics. — Salicylic  acid  and  its  salts  and  derivatives  have 
all  been  used  with  benefit  in  rheumatism.  The  greater  the  pain  and 
higher  the  fever,  the  more  prompt  and  powerful  is  the  beneficial  ac- 
tion of  this  remedy.  Hence  it  is  better  in  young  subjects  than  in  the 
middle  aged  or  elderly.  It  is  best  given  to  rheumatics  in  doses  of  a 
grain  or  more,  repeated  every  half-hour  till  the  ears  begin  to  ring. 
This  gives  better  results  than  bulky  doses  that  may  irritate  the 
stomach.  As  a  preventive  of  cardiac  affections  it  does  not  equal  the 
alkaline  treatment.  The  salicylates  of  iron  and  quinine  may  be  em- 
ployed in  suitable  cases. 

Acute  forms  of  myalgia,  such  as  lumbago,  torticollis,  pleuro- 
dynia,  and  the  numerous  forms  of  abdominal  and  dorsal  myalgia, 
are  quite  satisfactorily  relieved  by  this  agent.  Gout  and  rheumatoid 
arthritis  are  also  relieved  by  an  agent  that  stops  fermentation  in  the 
alimentary  tract;  but  the  writer  has  never  obtained  the  slightest 
benefit  from  it  or  any  form  of  salicin  in  gonorrheal  rheumatism. 

Chronic  forms  of  the  above  affections  are  only  benefited  by 
salicyl  as  it  checks  acid  fermentation.  Many  maladies  may  be 
traced  to  this  source,  neuralgias,  neuroses,  skin  diseases,  iritis,  and 
tonsillitis.  Gay  gave  the  acid  successfully  for  Meniere's  disease,  in 


336  SALICIN.     SALICYLIC  ACID 

doses  of  gr.  10  daily.  Strizower  recommended  it  for  gall-stones,  gr. 
10  four  times  a  day;  Shoemaker  for  worms,  gr.  8  hourly  for  five 
doses ;  for  the  foul  breath  of  phthisis ;  Monin  for  diabetes. 

As  an  antiseptic  antipyretic  this  acid  has  been  given  in  typhoid 
fever,  pneumonia,  erysipelas  and  phthisis,  but  especially  in  blood- 
poisoning,  pyemia,  sapremia,  etc.  De  Rosa  claimed  it  was  prophy- 
lactic against  scarlet  fever.  Dr.  C.  A.  Bryce,  of  Richmond,  Va., 
finds  that  in  smallpox  it  reduces  fever,  relieves  pain  and  limits  the 
development  of  the  pustules. 

Salicylic  acid  quickly  checks  the  development  of  sarcinae 
ventriculi. 

As  an  analgesic  salicylic  acid  in  doses  of  gr.  x  has  relieved  the 
pangs  of  cancer.  Bernheim  injected  it  into  inoperable  forms  of 
cancer  of  the  cervix  uteri  in  five  cases,  with  decided  benefit.  His 
solution  was  made  with  90  grains  of  the  acid  in  an  ounce  of  distilled 
water,  adding  3  drams  of  glycerin  and  4  drams  of  alcohol ;  of  this 
he  injected  30  minims  into  the  substance  of  the  tumor  for  five  suc- 
cessive evenings. 

Shoemaker  recommends  salicin  as  a  useful  bitter  tonic  in  feeble 
digestion ;  and  for  the  diarrhea  of  phthisis,  and  chronic  diarrhea  of 
children.  Maclagan  preferred  it  to  the  acid  in  rheumatism,  as  less 
depressing;  also  in  neuralgias  and  coryzas.  Turner  used  it  in  200 
cases  of  influenza  with  great  benefit.  Cheron  advised  it  in  pelvic 
pains  of  rheumatic  origin,  in  metritis,  cellulitis  and  peritonitis. 

Cushny  says  that  salicylic  acid  promotes  the  absorption  of  serous 
effusions,  pleural  and  subretinal,  in  some  unknown  way. 

Van  Renterghem  advises  the  salicylate  of  ammonia  in  fetid 
dyspepsia,  pulmonary  gangrene,  typhoid  fever,  dysentery,  and  in 
flatulence ;  this  salt  decomposing  in  the  digestive  tube  acts  by  both 
acid  and  base.  Fuerbringer  showed  that  the  acid  was  powerless  in 
septicemia  and  pyemia.  Bartels  showed  that  persons  saturated  with 
the  acid  did  not  escape  typhoid  or  erysipelatous  infection. 

Van  Renterghem  recommends  salicylate  of  lithia  for  am- 
moniacal  urine. 

Salicin  was  once  recommended  for  ague  but  proved  less  effective 
than  quinine.  Many  persons  cannot  take  the  ordinary  salicyl  prep- 
arations but  find  among  the  numerous  modifications  on  the  market 
others  which  fully  affords  the  benefits  without  the  disadvantages. 

The  dose  of  salicin  as  a  tonic  is  a  grain  before  each  meal.  It  is 
soluble  in  water  and  in  alcohol. 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


SANGUINARINE  337 

In  gastric  fermentation  quinine  salicylate,  gr.  1-6  every  half  to 
one  hour,  is  quite  effective. 

SANGUINARINE. 

Standard  granule — Gr.  1-67,  gm.  .001. 

Sanguinarine  is  an  alkaloid  from  bloodroot,  Sanguinaria  Cana- 
densis.  It  has  also  been  found  in  Chelidonium  majus,  and  in 
Eschscholtzia  Californica.  Sanguinaria  also  contains  chelerythrine, 
protopine  and  gamma-homochelidonine.  The  only  form  in  which 
sanguinarine  is  used  in  medicine  is  the  nitrate. 

Small  doses  of  sanguinarine  increase  the  appetite  and  the  diges- 
tion, strengthen  the  heart  and  slow  the  pulse,  and  excite  the  respira- 
tory secretion.  Larger  doses  cause  a  sense  of  warmth  in  the 
stomach,  nausea,  sedate  the  heart  and  slow  the  pulse,  increase  the 
perspiration,  expectoration,  urine  and  bile,  and  the  menses.  Still 
larger  doses  cause  violent  vomiting,  even  catharsis,  vertigo,  troubled 
vision  and  great  prostration.  The  saliva  is  increased.  Violent 
gastrointestinal  irritation  ensues,  with  burning  pain,  relaxation,  and 
the  symptoms  of  collapse,  cold  clammy  skin,  dilated  pupils,  great 
thirst  and  anxiety,  the  spinal  reflexes  depressed,  and  death  from 
paralysis  of  the  respiratory  and  cardiac  centers. 

Sanguinarine  is  employed  by  the  eclectics  as  an  emetic,  in  con- 
junction with  lobelia,  in  various  febrile  complaints  when  it  is  de- 
sired to  thoroughly  cleanse  the  stomach  and  arouse  to  activity  the 
liver  and  glands  in  general.  Acting  gently  on  the  liver  it  is  used  in 
chronic  hepatitis ;  in  small  doses  for  atonic  dyspepsia,  gastric  and 
duodenal  catarrh  and  jaundice;  sick  headaches  with  torpid  liver;  for 
rheumatism,  dysentery  and  scrofula  with  bad  circulation ;  for  anemic 
amenorrhea  and  the  dysmenorrhea  of  debility,  with  chilliness  and 
headache;  hysteria;  hemoptysis  vicarious  in  character;  genital  de- 
bility of  men;  syphilides,  tinea,  hypertrophic  rhinitis  (Felter  and 
Lloyd). 

The  most  important  field  for  sanguinarine  is  in  pulmonary  af- 
fections. It  is  a  stimulant  expectorant,  and  especially  indicated  in 
the  very  aged  or  very  young,  when  the  sensibility  of  the  respiratory 
mucosa  is  low  and  the  patient  does  not  feel  the  need  of  coughing  to 
rid  the  tract  of  accumulating  secretions.  In  this  particular  condi- 
tion sanguinarine  has  no  equal.  It  arouses  the  sensibility  and  makes 
the  patient  cough  harder  until  the  secretion  is  ejected  and  the  danger 
past.  Great  care  must  be  taken  not  to  exceed  the  stimulant  dose  and 


338  SANTONIN 

get  the  sedation  and  nausea  of  overdoses.  The  indication  for  this 
remedy  may  arise  in  pneumonia,  bronchitis,  phthisis,  and  especially 
in  capillary  bronchitis. 

Another  indication  for  sanguinarine  is  found  in  acute  respiratory 
catarrhs.  The  existence  of  disease  in  these  tissues  predicates  a  con- 
dition of  low  vitality  there — else  the  tissues  would  have  been  able  to 
resist  the  attack  of  disease-producing  agencies  and  throw  off  the 
malady.  Hence  the  indication  for  a  special  inciter  of  the  vitality  of 
these  tissues,  such  as  we  find  in  sanguinarine.  How  far  this  princi- 
ple of  therapeutics  can  be  carried  is  uncertain.  In  acute  pharyngitis 
the  application  of  a  strong  mixture  of  hydrochloric  acid,  potassium 
chlorate  and  tincture  of  iron,  in  which  free  chlorine  is  present,  has 
frequently  aborted  the  attack  when  applied  early.  The  action  may 
have  been  antiseptic,  stimulant,  vital  incitant,  or  simply  astringent — 
and  we  incline  to  the  latter  view.  If  sanguinarine  exerts  the  action 
suggested,  it  does  so  when  given  in  doses  strictly  physiologic,  that 
is,  just  short  of  those  arousing  notable  symptoms. 

Felter  and  Lloyd  further  recommend  this  agent  in  acute  and 
chronic  nasal  catarrh,  humid  asthma,  whooping-cough,  membranous 
croup,  and  scarlatinal  sore  throat. 

Specific  Indications. — Tickling  or  irritation  of  the  throat,  with 
cough,  burning  or  irritation  in  fauces,  larynx,  pharynx  or  nose,  with 
red  surface  and  thin,  acrid,  burning  or  smarting  discharge,  dryness 
of  nasopharynx  or  throat  and  sharp  lancinating  pain,  and  a  feeling 
as  if  the  walls  of  the  throat  rubbed  against  each  other;  poststernal 
constriction,  uneasiness  at  suprasternal  notch  with  difficulty  in 
breathing;  uneasiness  and  burning  in  stomach  with  nervousness. 

The  dose  of  sanguinarine  nitrate  as  a  stimulant  expectorant  is 
gr.  1-67  to  1-22  every  hour  till  effect,  relief  or  slight  nausea.  For 
anemic  amenorrhea  give  gr.  1-22  to  1-12  before  meals  and  at  bed- 
time, during  the  intermenstrual  period,  with  iron  arsenate;  adding 
apiol  during  the  menstrual  week. 

SANTONIN. 

Standard  granule — Gr.  1-6,  gm.  .01. 

Santonin  is  a  glucoside  from  German  wormseed,  Artemisia 
maritima. 

It  is  very  insoluble  in  water  but  rendered  soluble  by  alkalies  with 
which  it  unites  to  form  santoninates.  It  is  slightly  soluble  in  the 
stomach  but  most  of  it  passes  into  the  small  intestine  where  it  exerts 


SANTONIN  839 

its  influence.  Some  of  it  is  absorbed  into  the  circulation,  causing 
a  peculiar  disorder  of  vision,  things  appearing  to  the  patient  of  a 
yellowish  green.  The  urine  assumes  the  same  color.  If  very  large 
doses  are  taken  the  darker  colors  become  invisible,  blue  seems  green, 
and  visual  hallucinations  may  occur.  The  senses  of  taste,  smell,  and 
rarely  hearing,  may  be  deranged.  Very  large  doses  cause  twitching 
of  the  head  muscles,  rolling  of  the  eyes,  grinding  teeth,  followed  by 
epileptiform  convulsions;  with  contractions  of  the  muscles  during 
the  intervals.  Death  during  the  convulsions  is  due  to  asphyxia. 
Confusion,  nausea  and  vomiting  may  occur  from  ordinary  doses,  or 
aphasia.  The  convulsions  are  attributed  to  stimulation  of  the  cere- 
bral cortex,  the  interval  contractions  to  increased  activity  of  the 
parts  lying  between  the  cerebral  peduncles  and  the  medulla 
(Cushny).  Large  doses  also  affect  the  cord.  Santonin  lowers  the 
temperature  in  most  animals  (Harnack).  It  is  partly  oxidized  in  the 
tissues  and  is  excreted  in  the  urine  and  feces  in  several  forms.  Two 
days  are  required  for  the  elimination  of  an  ordinary  dose.  The 
quantity  of  urine  and  frequency  of  micturition  are  increased. 
Urticaria  has  appeared  after  its  prolonged  administration ;  and  even 
from  one  three-grain  dose. 

Therapeutics. — Santonin  is  the  standard  remedy  for  round  worms. 
Solutions  do  not  kill  these  worms  outside  of  the  body,  and  its  rem- 
edial action  is  obscure.  Von  Schroeder  suggests  that  it  renders  the 
intestine  an  unpleasant  abiding  place  for  them — which  is  very  little 
explanation.  Precise  observations  made  in  a  London  hospital 
showed  that  santonin  did  not  entirely  remove  the  parasites,  since 
their  eggs  continued  to  appear  in  the  stools  after  full  treatment  with 
it.  Against  thread  and  tape  worms  santonin  is  useless. 

The  dose  of  santonin  for  a  child  three  years  old  is  a  grain  three 
times  a  day.  It  is  usual  to  combine  small  doses  of  calomel — gr.  % 
— with  it.  Lewin  advises  giving  santonin  in  castor  oil  to  hinder 
absorption  from  the  stomach.  Empty  the  bowels  first  by  suitable 
laxatives,  then  give  the  day's  dose  of  santonin,  and  follow  in  four 
hours  with  a  smart  laxative.  Otherwise  the  worms  may  be  digested 
and  the  efficacy  of  the  treatment  be  uncertain. 

In  poisoning  by  santonin,  empty  the  stomach  and  bowels 
promptly,  control  the  convulsions  by  chloroform  or  chloral,  and 
sustain  the  powers  as  failure  threatens. 

The  notable  effect  of  santonin  on  the  nerve  centers  has  led  to 
its  employment  in  other  maladies.  Lydston  gives  it  for  epilepsy, 
instead  of  the  bromides.  It  is  a  good  antispasmodic  for  children, 


340  SCILLITIN 

says  Shoemaker ;  but  we  are  well  supplied  with  approved  agents  in 
this  respect.  Lydston  begins  with  doses  of  gr.  2 — 5,  for  adults,  and 
pushes  it  to  tolerance.  Saturation  is  denoted  by  the  yellow  urine, 
xanthopsia  and  vesical  irritability. 

Negro  found  santonin  relieve  the  painful  crises  of  ataxia ;  giving 
it  up  to  gr.  22  daily. 

Santonin  has  been  given  for  color  blindness,  with  some  benefit 
in  noncongenital  cases.  In  other  ocular  maladies  it  has  not  suc- 
ceeded. Nocturnal  enuresis  sometimes  yields  to  it  (Shoemaker). 
In  anemic  amenorrhea  Whitehead  gave  santonin  gr.  10  at  bedtime 
repeated  once,  with  benefit;  and  Masterman  found  this  relieve 
uterine  colic  dependent  on  suppression  of  the  menses. 

SCILLITIN. 

Standard  granule^-GV.   1-67,  gm.  .001. 

Scillitin  is  a  glucoside  from  squill,  Scilla  maritima. 

From  squill  Merck  obtained  three  principles,  scillipicrin, 
scillitoxin  and  scillin.  Von  Jarmerstedt  and  Kurtz  obtained  scillain, 
an  amorphous  bitter  principle,  soluble  in  water  or  in  alcohol. 

Vogel  describes  scillitin  as  a  solid  diaphanous  mass,  colorless,  of 
resinous  fracture,  pulverizable,  at  first  bitter,  then  sweetish,  very 
hygroscopic,  easily  soluble  in  water,  rectified  spirit  or  acetic  acid. 

Tilloy  separated  from  this  body  a  purer  scillitin  and  a  non- 
crystallizable  sugar.  This  body  does  not  dissolve  readily  in  water 
but  freely  in  alcohol.  Landerer  and  Marais  believed  they  had  dis- 
covered an  alkaloid,  scillitine,  which  is  probably  Merck's  scillitoxin. 
Jarmerstedt's  scillain  is  pronounced  by  Van  Renterghem  a  pure 
scillitoxin.  Of  this  a  dose  of  i-io  milligram  kills  a  frog,  2  milli- 
grams a  cat.  It  shows  close  analogies  with  digitalin. 

Fronmueller  pronounced  scillipicrin  a  diuretic  which  had  no 
superior.  Out  of  17  cases  of  grave  oliguria  treated  with  it  15  were 
successful.  It  was  not  suitable  for  hypodermic  use,  the  irritation 
being  too  great. 

Von  Schroff  found  the  action  of  scillitin  bearing  upon  the 
ganglionic  nervous  system  and  the  secretory  organs,  especially  the 
kidneys  and  the  respiratory  mucosa.  In  massive  doses  it  occasioned 
nephritis  and  gastroenteritis,  with  parenchymatous  pulmonary 
hemorrhages.  Lethal  doses  killed  by  ganglionic  paralysis,  especially 
of  the  heart.  He  placed  this  body  with  colchicine  and  helleborein. 

Gubler  found  scillitin  toxic  in  doses  of  gr.  5-6,  smaller  doses 
causing  acute  gastroenteritis.  It  acted  as  a  violent  emeto-cathartic. 


SCILLITIN  341 

Narcotism  followed,  and  death  from  heart  paralysis.  Applied 
endermically  it  was  quicker,  and  the  effects  almost  purely  narcotic. 
Koenig  after  long  experimentation  on  animals  obtained  no  toxic 
phenomena. 

Huesemann  concluded  that  squill  in  medicinal  doses  causes  slow- 
ing of  the  pulse  with  a  rise  in  arterial  tension ;  lasting  some  hours ; 
light  laxative  action  with  liquid  stools;  long-continued  use  dis- 
ordered the  digestion ;  no  narcotic  phenomena  were  noticed.  Exces- 
sive doses  caused  nausea,  vomiting,  diarrhea,  slowed  the  pulse  to  40, 
prostration,  narcosis,  and  convulsions.  One  dose  of  22^2  grains  of 
squill  killed  a  man.  Toxic  doses  suppress  the  diuresis  and  cause 
hematuria. 

In  medicinal  doses  squill  reduces  the  frequency  of  the  heart  and 
increases  its  force,  as  well  as  the  vascular  pressure,  increases  the 
excretion  of  urine,  and  of  the  respiratory  mucus.  Toxic  doses  cause 
gastrointestinal  inflammation,  and  kill  by  paralyzing  the  heart.  The 
active  principle  which  most  closely  represents  the  plant  is  scillain 
(Van  Renterghem). 

Therapeutics. — Scillitin  may  be  employed  as  a  substitute  for 
digitalin,  over  which  it  has  some  advantages — not  cumulative,  etc. 
It  should  not  be  given  in  irritative  conditions  of  the  kidneys,  or  of 
the  stomach  or  bowels ;  even  though  Huesemann  claimed  that 
clinical  experience  did  not  warrant  this  contraindication.  There 
are  other  remedies  that  will  do  the  work,  in  case  of  doubt. 

Scillitin  has  been  employed  in  various  dropsies,  in  combination 
with  digitalin  and  calomel ;  and  this  has  proved  more  effective  than 
either  agent  separately.  Give  scillitin  gr.  1-67,  digitalin  gr.  1-67, 
and  calomel  gr.  1-12,  together,  every  two  hours  till  the  result  is 
satisfactory.  In  advanced  cardiac  dropsies  when  other  diuretics 
have  lost  their  effects  this  combination  will  frequently  prove  sur- 
prisingly effective.  But  the  principles  of  treatment  of  this  malady 
comprise  something  far  beyond  the  simple  abstraction  of  a  few 
ounces  of  serum  from  the  body.  If  the  dry  diet,  and  elimination,  are 
not  comprehended,  the  results  of  any  treatment  will  be  but  transitory. 

Scillitin  resembles  sanguinarine  in  its  power  of  increasing  the 
sensibility  of  the  respiratory  mucosa,  and  making  the  patient  cough 
harder.  This  and  a  slight  increase  of  the  mucous  secretion  comprise 
its  effects  in  respiratory  affections,  and  the  combination  of  squill 
with  sedatives  like  paregoric  is  one  of  the  curious  instances  of  in- 
compatible mixtures  common  in  the  old  polypharmacy.  No  case  can 
be  imagined  that  requires  the  two  in  the  same  case  at  the  same  time. 


SCUTELLARIN.    SENECIN 

The  dose  of  scillitin  is  gr.  1-67  every  hour  or  two;  or  five  gran- 
ules every  four  hours,  as  a  maximum. 

SCUTELLARIN. 

Standard    granule — Gr.    1-6,    gm.  .01. 

Scutellarin  is  a  concentration  from  skullcap,  Scutellaria  lateri- 
flora.  It  contains  a  glucoside  obtained  in  acicular  crystals  by  Myers. 

Felter  and  Lloyd  say  that  scutellaria  is  tonic,  nervine  and  anti- 
spasmodic;  which  has  proved  especially  useful  in  chorea,  convul- 
sions, tremors,  intermittent  fever,  neuralgia,  and  many  nervous  af- 
fections. In  delirium  tremens  it  induces  sleep.  It  is  useful  for  the 
nervousness  of  teething  children.  In  nervous  excitability  and  rest- 
lessness or  wakefulness,  with  or  after  acute  or  chronic  maladies, 
from  physical  or  mental  overwork,  or  other  causes,  it  is  useful.  It 
influences  the  cerebrospinal  centers,  controlling  nervous  irritation; 
hence  its  value  in  functional  cardiac  affections. 

Specific  Indications. — Nervousness,  in  or  after  diseases;  or  from 
exhaustion ;  or  teething ;  nervousness  manifested  by  muscular  action  ; 
tremors,  subsultus,  hysteria,  inability  to  control  muscles;  functional 
cardiac  disorders  purely  nervous,  with  intermittent  pulse. 

Ellingwood  recommends  scutellaria  for  paralysis  agitans,  and 
with  cimicifuga  in  chorea;  for  insomnia  from  restlessness  or  ex- 
citability, and  in  prolonged  fevers ;  it  promotes  sleep  and  stimulates 
the  kidneys  and  skin  to  increased  activity.  The  soothing  effect  con- 
tinues after  the  remedy  has  been  discontinued. 

The  writer  has  employed  scutellarin  to  some  extent,  and  finds 
it  closely  resembling  cypripedin  and  valerian  in  effects.  It  is  a  mild, 
comforting  nervous  sedative,  relieving  nervous  restlessness  as  well 
as  the  bromides  and  without  their  destructive  effects  upon  the  diges- 
tion and  the  vitality.  In  fact,  this  remedy  should  be  classed  as  a 
nerve  strengthener  instead  of  a  sedative.  Subduing  nervous  irrita- 
bility is  not  sedation  but  rather  lifting  the  function  up  to  a  plane 
where  it  can  act  normally. 

The  dose  of  scutellarin  is  from  one  to  five  grains,  every  hour  till 
effect;  the  small  dose  is  usually  sufficient.  Many  times  such  a 
remedy  is  all  that  is  sufficient,  and  strychnine  is  not  needed. 

SENECIN. 

Standard  granule — Gr.  1-6,  gm.  .01. 

Senecin  is  a  concentration  from  Senecio  Jacoboea,  or  ragwort. 

Two  alkaloids  have   been    found    in    this    plant,    senecine    and 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


SENECIN  343 

senecionine.  Bunch  found  that  it  caused  a  rise  in  the  vascular  pres- 
sure, with  constriction  of  the  peripheral  blood-vessels  and  those  of 
the  intestines.  Under  large  doses  the  general  pressure  fell,  the  in- 
testinal vessels  dilated,  and  the  contractions  of  the  intestinal  coats 
were  inhibited.  These  effects  were  obtained  from  the  alcoholic  ex- 
tract. The  watery  extract  caused  a  fall  of  vascular  pressure  and 
cardiac  inhibition  (Shoemaker). 

Senecin  has  been  mainly  employed  as  a  regulator  of  menstrua- 
tion ;  one  of  the  popular  titles  of  the  plant  being  the  Female  Regu- 
lator. Delache  and  Heim  found  the  solid  extract  act  well,  giving 
gr.  36  daily.  Bardet  and  Bolognesis  used  it  in  20  cases  of 
amenorrhea  and  dysmenorrhea,  and  found  it  had  the  constant  prop- 
erty of  inducing  the  menstrual  flow  and  relieving  the  pain.  Murrell 
speaks  highly  of  this  agent  as  an  emmenagog,  first  treating  the 
anemia  and  then  giving  senecin.  One  of  the  names  of  this  plant 
is  "old  man,"  and  it  has  been  advised  for  impotence,  with  doubtful 
benefits. 

Felter  and  Lloyd  consider  senecio  of  value  in  female  disorders, 
relieving  irritation  and  strengthening  function  ;  promoting  menstrua- 
tion when  there  is  no  structural  lesion ;  in  dysmenorrhea,  sterility 
and  chlorosis;  in  menorrhagia  given  during  the  intermenstrual  in- 
terval and  at  ovulation ;  for  tenesmic  and  painful  micturition  of 
either  sex ;  leucorrhea  with  weakness  of  the  vaginal  walls  allowing 
uterine  displacement,  with  engorgement ;  male  genital  disorders  with 
pelvic  weight  and  full,  tardy  or  difficult  urination,  and  dragging 
sensation  in  the  testicles ;  for  tardy  digestion  from  congested  or  re- 
laxed gastric  mucosa ;  capillary  hemorrhages,  hematuria,  and  bloody 
albuminuria;  pulmonary  hemorrhages;  an  excellent  diuretic  in 
gravel,  etc.,  specific  in  strangury;  dysentery. 

Specific  Indications. — Atony  of  reproductive  organs  with  im- 
paired function ;  uterine  enlargement,  uterine  or  cervical  leucorrhea ; 
difficult  tenesmic  urination ;  dragging  in  testicles ;  perineal  weight 
and  fullness. 

Ellingwood  says  senecin  works  best  in  a  general  hyperemic  ir- 
ritable and  atonic  condition  of  the  pelvic  organs ;  the  results  are  not 
immediate;  in  engorged  conditions  of  the  male  sexual  organs,  im- 
potence, an  active  diuretic;  of  value  in  gonorrhea  and  gleet,  and 
prostatorrhea,  sexual  irritability  of  the  male;  overcomes  conditions 
that  cause  food  to  lie  heavy  on  the  stomach ;  acts  in  harmony  with 
viburnum,  helonias,  aralia,  mitchella,  etc. 

In  the  trials  the  writer  has  made  of  senecin  he  has  had  no  re- 


344  SODIUM   SUCCINATE 

suits  whatever,  from  doses  up  to  five  grains  a  day.  It  is  evidently 
requisite  that  much  larger  doses  should  be  given,  and  as  it  does  not 
act  very  quickly,  the  remedy  should  be  continued  for  a  month  or 
more. 

SODIUM    STJOCINATE. 

Standard  tablet — Gr.  v,  gm.  .33. 

Some  20  years  ago  the  writer's  attention  was  directed  to  sodium 
succinate  as  a  remedy  for  gall-stones.  He  commenced  its  use  for 
that  malady,  giving  five  grains  before  each  meal  and  at  bedtime,  and 
continuing  its  administration  for  a  year.  The  paroxysms  of  the  dis- 
ease became  gradually  less  frequent  and  less  severe,  until  within 
the  period  named  they  ceased  entirely. 

This  experience  has  been  repeated  with  every  case  seen  by  the 
writer  since,  and  in  all  except  two  cases  the  above  result  has  been 
attained.  In  one  of  these,  a  young  woman  with  the  intermittent 
febrile  form,  simulating  malaria,  the  remedy  was  used  intermittent- 
ly and  the  test  was  not  a  fair  one.  In  the  other  a  physician  came  to 
the  writer  with  the  morphine  habit  from  25  years  of  this  malady, 
and  within  a  week  the  gall-bladder  suppurated  and  surgical  inter- 
vention was  imperatively  demanded.  After  years  of  suffering  and 
'many  operations  he  is  well.  With  these  exceptions  every  case  has 
recovered  under  the  use  of  the  succinate. 

What  does  it  do?  We  do  not  know.  We  have  never  had  the 
opportunity  to  perform  an  autopsy  on  a  man  who  had  been  taking 
the  drug.  Does  it  dissolve  the  calculi?  We  think  not.  Possibly  it 
does.  Does  it  subdue  the  catarrhal  affection  of  the  biliary  passages 
and  the  duodenum?  We  think  it  does.  It  may  act  as  an  antiseptic 
or  germicide,  or  in  some  other  manner.  All  we  know  about  it  is 
comprised  in  the  statement  herein  given.  No  theory  is  advanced ; 
the  practically  unvarying  success  of  twenty  years  is  a  phenomenon 
for  the  consideration  and  testing  of  our  readers.  As  to  the  diagnosis, 
there  have  been  a  number  of  cases  which  had  been  diagnosed  as 
gall-stones  by  the  first  surgeons  of  the  country,  and  the  knife  pre- 
sented as  the  only  treatment  worth  consideration — even  the  date  set 
for  operation ;  and  yet  these  cases  are  among  those  which  recovered 
on  the  succinate  treatment. 

The  succinate  is  not  a  remedy  for  the  paroxysm. 

Dr.  W.  H.  Nunn  writes  that  he  attended  a  man  with  biliary 
calculi,  and  gave  him  the  sodium  succinate  treatment.  The  man 


SPARTEINE 


346 


never  had  another  paroxysm.    Many  cases  have  been  reported  to  the 
writer  where  others  have  obtained  results  fully  equal  to  our  own. 

SPARTEINE. 

Standard  granules— Sulphate  gf.  1-67,  gm.  .001 ;  gr.  1-6,  gm.  .01. 

Sparteine  is  an  alkaloid  derived  from  Cytisus  scoparius,  or 
broom.  Broom  tops  contain  the  volatile  liquid  alkaloid  sparteine, 
and  a  crystallizable  neutral  principle,  scoparin. 

Cushny  says  that  sparteine  closely  resembles  cicutine  in  its  ef- 
fects, the  central  nervous  system  being  but  little  affected  by  the 
former,  which  paralyzes  the  peripheral  motor  nerve  ends,  and  prob- 
ably the  terminations  around  the  cells  of  the  sympathetic  ganglia. 
Sparteine  depresses  the  heart  more  than  cicutine,  making  the  rhythm 
slow  and  contractions  weak.  It  increases  arterial  tension  less  than 
cicutine.  Sparteine  is  very  much  less  toxic  than  cicutine  or 
gelseminine.  It  kills  by  paralyzing  the  ends  of  the  phrenic  nerves 
in  the  diaphragm.  The  diuretic  action  of  broom  is  due  to  the 
scoparin. 

Sparteine  lowers  reflex  action.  Shoemaker  says  it  raises  arterial 
tension  for  five  hours. 

Cerna  found  it  caused  a  brief  period  of  increased  muscular  ir- 
ritability and  reflex  action,  followed  by  depression ;  spinal  con- 
vulsions, generally  tetanic;  first  increased  and  then  depressed  the 
heart's  force  and  rate ;  similarly  increasing  and  later  depressing  the 
blood  pressure.  Death  is  caused  by  paralysis  of  respiration.  See 
asserted  that  sparteine  promptly  and  strongly  reduced  the  size  of  the 
heart.  He  gave  it  for  weak  and  irregular  heart  action,  in  doses  of 
gr.  1-6  to  1-4  every  four  hours,  especially  in  heart  failure  from 
mitral  disease.  In  irregular  heart  action  it  proved  serviceable. 
Gluzinski  found  doses  under  a  grain  best. 

Shoemaker  speaks  well  of  sparteine  as  a  cardiac  tonic,  in  the 
cases  where  digitalin  is  usually  administered.  It  has  been  recom- 
mended in  exophthalmic  goiter,  tobacco  heart,  to  prevent  uremia,  in 
angina  pectoris,  chorea  with  endocarditis,  rheumatic  heart  diseases, 
the  withdrawal  symptoms  following  stoppage  of  morphine,  as  a  pre- 
liminary to  chloroform  anesthesia  in  patients  with  weak  or  diseased 
hearts,  to  regulate  the  disturbed  heart  in  young  consumptives,  etc. 

There  is  here  a  curious  contradiction.  If  sparteine  can  be  given 
with  advantage  to  the  diseased  hearts  before  chloroform  anesthesia, 
there  is  hardly  a  doubt  that  it  acts  as  a  cardiac  tonic.  Possibly 


346  STROPHANTHIN 

Cushny's  conclusions  are  based  on  Schmiedeberg's  experiments  on 
animals  with  much  larger  doses  than  are  given  in  the  cases 
described.  The  writer  has  given  sparteine  as  a  cardiac  tonic  in  doses 
below  a  grain  a  day,  and  found  it  especially  beneficial  in  aged  per- 
sons where  it  is  necessary  to  continue  the  remedy  longer  than  he 
cared  to  use  digitalin. 

Sparteine  acts  as  a  diuretic  by  increasing  the  vascular  tension  in 
small  doses,  as  is  the  case  with  digitalin.  Scoparin  is  a  direct  and 
powerful  diuretic,  increasing  the  quantity  of  urine  and  the  excretion 
of  urea. 

STROPHANTHIN. 

Standard  granule — Gr.  1-500,  gm.  .000125 ;  gr.  1-134,  gm.  .0005. 

Strophanthin  is  a  glucoside  derived  from  Strophanthus  hispidus, 
and  some  other  species  of  Strophanthus.  Several  principles  have 
been  isolated  from  the  various  species  of  Strophanthus,  and  the 
name  has  been  applied  to  derivatives  differing  in  their  strength  even 
to  the  ratio  of  one  to  90.  It  is  absolutely  essential  that  but  one  of 
these  should  be  employed,  to  obtain  uniformity  and  safety  in  its  use. 
Arnaud's  Strophanthin  has  the  formula  C21H48O12.  Fraser  con- 
siders it  the  only  active  principle  of  the  plants,  looking  on  strophan- 
thidin  as  a  decomposition  product.  Strophanthin  is  a  crystallizable 
glucoside,  soluble  in  water  and  in  alcohol.  It  is  a  more  powerful 
local  anesthetic  than  cocaine.  It  causes  passive  congestion  and  may 
cloud  the  cornea.  It  is  bitter  and  in  small  doses  promotes  digestion. 
As  a  cardiac  tonic  it  closely  resembles  digitalin,  and  a. detailed  ac- 
count of  its  action  would  simply  repeat  what  has  been  said  at  length 
under  that  head.  The  principal  difference  in  their  action  is  in  the 
effect  upon  the  vascular  pressure,  which  is  raised  by  digitalin  much 
more  than  by  Strophanthin.  In  fact,  the  only  increase  in  the  arterial 
tension  caused  by  the  latter  is  what  may  be  caused  by  the  increase 
in  the  force  of  the  heart  and  the  consequent  greater  quantity  of 
blood  driven  into  the  vessels. 

Strophanthin  does  not  disturb  the  digestion,  nor  has  it  any 
cumulative  effect,  that  bugbear  of  the  older  physicians  who  did  not 
employ  the  Germanic  digitalin.  The  tonic  effect  is  not  so  enduring 
as  that  of  digitalin.  The  quieting  effect  on  the  nervous  centers  at- 
tributed to  Strophanthin  is  simply  that  seen  after  any  cardiac  tonic 
rightly  administered. 

If  given  continuously  for  some  time  diarrhea  is  apt  to  result. 

Fraser  specially  recommended  Strophanthus  in  affections  of  the 


STRYCHNINE  847 

right  heart,  and  of  the  aortic  valve,  where  digitalin  is  contra- 
indicated.  Wilcox  says  success  in  its  use  demands  a  good  prepara- 
tion, its  use  in  not  too  large  or  too  frequent  doses,  avoidance  of  it  in 
fully  or  over-compensated  hearts,  or  in  those  presenting  advanced 
muscular  degeneration  or  mechanical  defects  of  high  degree.  He 
considers  it  the  drug  of  choice  in  all  cases  when  we  wish  to  estab- 
lish compensation;  all  cases  of  arterial  degeneration  when  more 
energetic  cardiac  contraction  is  required;  all  cardiac  cases  where 
diuresis  is  desired ;  all  weak  or  irritable  hearts ;  and  all  cases  of  heart 
disease  in  childhood  or  old  age.  This  leaves  little  room  for  digitalin. 
But  Balfour  denies  most  of  this,  holding  that  when  heart  cases  re- 
quire anything  beyond  rest,  they  need  a  remedy  to  restore  the 
elasticity  of  the  heart  muscle,  and  this  digitalin  does  best. 

Strophanthin  has  been  advised  in  bronchial  asthma,  whooping- 
cough,  hypodermically  in  chills  of  nervous  character,  malarial,  and 
urethral.  Uremia  and  dyspnea  of  nephritis  are  relieved  by  this 
remedy.  It  has  succeeded  in  exophthalmic  goiter,  where  it  was 
given  in  very  large  doses. 

If  strophanthin  causes  cold  sweating  and  nausea,  coffee  and 
stimulants  should  be  given. 

The  dose  of  strophanthin  should  be  regulated  by  the  effect  on  the 
pulse.  One  of 'the  weaker  granules  may  be  given  every  hour  or  two 
till  the  desired  cardiac  tonicity  has  been  attained,  and  then  often 
enough  to  keep  up  this  effect.  If  the  stronger  granules  are  used  one 
every  four  to  six  hours  is  the  dose  for  an  adult  at  the  beginning,  and 
this  should  not  be  exceeded  until  the  tolerance  has  been  ascertained. 


STRYCHNINE. 

Standard  granules — Arsenate  gr.  1-134,  gm.  .0005 ;  gr.  1-67,  gm.  .001 ; 
gr.  1-30,  gm.  .002;  hypophosphite  gr.  1-134,  gni.  .0005;  nitrate  gr.  1-67,  gm. 
.001;  sulphate  gr.  1-134,  gm.  .0005;  gr.  1-67,  gm.  .001;  gr.  1-30,  gm.  .002; 
valerianate  gr.  1-134,  gm.  .0005. 

Strychnine  is  an  alkaloid  derived  from  Strychnos  nux  vomica. 
With  it  is  found  the  closely  allied  alkaloid,  brucine.  In  the  same 
group  we  place  thebaine,  calabarine,  laudanine,  and  curarine ;  while 
several  other  less  known  alkaloids  are  probably  to  be  placed  here  also. 
None  of  these  has  been  studied  as  thoroughly  as  strychnine,  and 
it  is  possible  that  each  may  sometime  be  found  to  fulfill  some  func- 
tions better  than  the  others.  Meanwhile  strychnine  has  come  into 
such  general  and  extensive  use  that  it  behooves  every  practician  to 


348  STRYCHNINE 

study  its  actions  and  powers  to  the  fullest  extent,  that  he  may  be 
able  to  recognize  its  effects,  remedial  and  toxic,  at  a  moment's  notice. 

Physiologic  and  Toxic  Actions. — When  a  toxic  dose  of  strychnine 
is  taken  the  first  effect  is  sharpening  of  the  special  senses,  with  stiff- 
ness of  the  muscles  of  neck  and  face.  The  reflexes  are  increased, 
and  slight  irritations  cause  quick  and  powerful  movements.  Tremors 
or  twitchings  of  the  extremities  occur,  and  are  followed  by  general 
convulsions,  the  extensors  especially  being  thrown  into  action.  The 
head  is  retracted,  opisthotonos  appears,  with  the  sardonic  grin. 
Respiratory  spasm  causes  cyanosis.  The  muscular  spasms  alternate 
with  relaxation,  when  the  reflex  irritability  is  low.  After  two  or 
three  convulsions  death  occurs,  the  respiration  not  being  resumed. 
In  some  cases  the  convulsions  subside  but  death  occurs  from 
asphyxia.  Very  large  doses  cause  death  by  paralysis  of  the  nerve 
centers  without  convulsions. 

The  action  is  directed  to  the  central  nervous  system.  The  cord 
is  affected  more  than  the  cerebrum.  The  intellect  is  not  directly  af- 
fected and  the  pain  is  exquisite.  Not  only  are  the  special  senses 
made  more  acute  but  the  field  of  vision  is  widened,  and  shades 
previously  indistinguishable  can  be  recognized. 

The  convulsions  are  due  to  stimulation  of  the  spinal  reflex  func- 
tion. They  may  be  prevented  by  excluding  external  irritations. 
The  tone  of  the  medulla  is  increased  by  small  doses,  and  affected  by 
large  ones  as  is  the  cord.  The  tendency  to  convulsions  is  lessened 
by  rhythmic  movements  of  any  description.  No  direct  effect  is 
exerted  on  any  of  the  voluntary  muscles. 

Large  doses  paralyze  the  motor  nerve  ends,  by  direct  action. 
Small  doses  quicken  and  deepen  the  respirations.  The  heart  is  not 
directly  affected  by  strychnine,  but  stimulation  of  the  center  of  in- 
hibition slightly  slows  it.  The  peripheral  arterioles  are  contracted 
by  stimulation  of  the  vasoconstrictor  center.  Remedial  doses  raise 
the  vascular  pressure  and  slow  the  pulse.  During  convulsions  the 
pressure  rises  very  high,  from  the  direct  action  and  from  the  blood 
being  forced  out  of  the  abdominal  vessels  by  the  violent  contraction 
of  the  muscles.  The  vasoconstriction  is  greatest  in  the  internal 
vessels,  those  of  the  skin  and  possibly  the  muscles  being  dilated. 
Cushny  attributes  this  to  stimulation  of  vasodilator  centers  in  the 
medulla.  The  heart  beats  long  after  respiration  ceases,  and  artificial 
respiration  may  keep  it  beating  indefinitely. 

Strychnine  acts  on  the  stomach  as  the  other  bitter  tonics,  in  small 
doses ;  and  is  absorbed  from  the  intestine. 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


STRYCHNINE  349 

From  the  enormous  increase  of  muscular  activity  strychnine 
raises  correspondingly  the  excretion  of  carbonic  acid  and  absorption 
of  oxygen.  No  rise  in  temperature  is  caused,  as  the  dissipation  of 
heat  through  the  skin  is  even  more  increased.  The  internal  tempera- 
ture falls  a  little  while  that  of  the  skin  rises.  Even  small  doses  cause 
the  glycogen  of  the  liver  and  muscles  to  disappear  (Demant). 

Strychnine  is  eliminated  mainly  by  the  kidneys,  the  process  last- 
ing a  week  or  more.  Part  is  excreted  into  the  stomach  and  part 
oxidized  in  the  tissues.  The  continued  use  of  strychnine  begets  a 
certain  degree  of  tolerance.  Trousseau  gave  it  in  ascending  doses 
up  to  and  exceeding  a  grain  a  day,  to  adults.  Man  is  more  suscepti- 
ble to  it  than  animals,  and  the  young  are  more  susceptible  than  the 
old. 

Strychnine  stimulates  the  peristaltic  movement  of  all  the  hollow 
viscera,  intestines  and  bladder.  Large  doses  may  cause  diarrhea. 
The  pupil  is  dilated.  Small  doses  promote  the  amylolytic  action  of 
the  pancreatic  juice  while  large  doses  suppress  its  secretion.  The 
genital  functions  in  both  sexes,  the  menstrual  flow,  testicular  secre- 
tion, erectile  power  and  venereal  appetite,  are  increased  by  strych- 
nine. 

The  absorption  of  strychnine  is  more  rapid  when  given  by  the 
rectum  than  by  the  stomach.  The  elimination  of  this  drug  by  the 
saliva  and  other  alimentary  secretions  tends  to  accumulate  it  in  the 
system  as  it  is  reabsorbed  from  the  lower  bowel.  Stocker  found 
flushing  of  the  face,  throbbing  head,  vertigo  and  faintness  to  be  the 
evidences  of  beginning  toxic  action,  or  saturation. 

The  slowness  of  its  absorption  and  elimination  renders  it  wise 
to  suspend  the  use  of  strychnine  for  intervals.  It  inhibits  the  move- 
ments of  the  leucocytes,  though  much  less  than  quinine.  A  bright 
red  eruption  is  mentioned  by  Shoemaker  as  having  been  exception- 
ally caused  by  strychnine. 

Death  has  resulted  from  half  a  grain  of  strychnine,  and  from 
three  grains  of  extract  of  nux  vomica ;  but  six  grains  of  strychnine 
have  been  taken  without  the  fatal  result.  Recovery  is  the  rule  if  the 
patient  survives  three  hours. 

Falconer  reported  a  case  of  chronic  poisoning,  the  symptoms  be- 
ing extreme  weakness,  muscular  pains,  stiffness  of  the  back  of  the 
neck,  clonic  convulsions  of  the  forearm  with  contractures  of  the 
finger  flexors,  vertigo,  amblyopia,  and  weak  but  regular  pulse.  She 
had  taken  gr.  1-30  four  times  a  day  for  eight  months  up  to  her 
death. 


350  STRYCHNINE 

The  diagnosis  of  strychnine  poisoning  may  be  made  by  the  tonic 
convulsions,  never  clonic  as  in  epilepsy;  the  jaw  is  not  first  attacked 
as  in  tetanus ;  in  tetany  other  than  the  cervical  muscles  are  affected 
with  persistent  rigidity;  in  hysteria  the  contractions  are  painless, 
and  the  history  and  aspect  of  the  case  are  radically  different;  in 
hydrophobia  the  mind  is  affected,  and  the  history  and  duration  of 
the  attack  differ. 

The  chemical  antidote  to  strychnine  is  tannic  acid.  Shoemaker 
speaks  of  cold  tea  or  coffee  as  being  available  sources.  The  stomach 
should  be  soon  washed  out  or  vomiting  induced,  as  the  tannate  of 
strychnine  is  slowly  soluble.  Anesthetize  the  convulsed  patient  be- 
fore trying  any  manipulation.  The  chloral  group  are  antidotes, 
with  physostigmine  and  possibly  pilocarpine.  All  relaxants  are 
antagonistic,  such  as  tobacco,  alcohol,  cicutine,  morphine,  glonoin, 
etc.  Turner  claimed  that  lard  was  a  remedy,  but  this  seems  to  be 
simply  a  means  of  delaying  absorption. 

Therapeutics. — Strychnine  stands  at  the  head  of  remedies  for 
poisoning  from  venomous  snakes,  of  all  varieties.  The  effect  of  the 
venom  is  a  paralysis  of  the  vasoconstrictors  of  the  abdominal  organs, 
by  which  the  blood  from  the  whole  body  is  heaped  up  in  the  ab- 
domen, and  the  patient  dies  from  cerebral  anemia.  This  effect  is  di- 
rectly antagonized  by  strychnine.  It  must  be  given  in  full  toxic  doses 
and  repeated  as  required,  without  reference  to  its  ordinary  dosage. 
The  discoverer  urged  from  gr.  1-5  to  1-3  hypodermically  as  a  first 
dose,  and  then  enough  to  keep  up  the  toxic  rigidity  secured.  The 
failures  are  due  to  the  fear  or  carelessness  by  which  this  dosage  for 
effect  is  not  persisted  in  until  the  danger  is  past.  The  paralysis 
keeps  recurring  for  days  perhaps,  and  the  dosage  requires  intelli- 
gent, fearless  and  persistent  repetition. 

The  close  similarity  between  the  symptoms  of  snake  poison  and 
those  of  the  Amanita  phalloides,  the  deadliest  of  poisonous  mush- 
.  rooms,  has  led  to  the  use  of  strychnine  similarly.  This  is  strictly 
correct,  and  we  expect  similarly  good  results  to  accrue.  A  some- 
what similar  condition  exists  in  persons  overcome  by  enormous 
quantities  of  alcohol,  as  where  fools  bet  on  their  ability  to  drink  a 
pint  or  quart  of  whisky  at  a  draught.  The  hypodermic  use  of 
enough  strychnine  affords  the  best  chance  of  saving  the  life. 

In  doses  of  gr.  1-67  any  of  the  salts  of  strychnine  forms  a  good 
bitter  tonic  for  weak  digestions,  but  it  is  better  to  save  this  great 
remedy  for  great  uses,  and  employ  the  equally  efficient  and  far  safer 
quassin  for  an  appetizer.  In  very  small  doses,  gr.  1-500  of  the 


STRYCHNINE  351 

arsenate  is  best,  it  is  useful  for  many  forms  of  vomiting-,  that  of  preg- 
nancy and  of  drunkards  especially.  Give  every  hour  till  toned  up 
enough.  When  alcohol  has  been  used  habitually  and  an  effort  is 
made  to  break  off  the  habit,  there  is  a  miserable  sense  of  debility,  of 
utter  prostration  and  nervelessness,  mental  and  physical;  and  this 
is  best  met  by  strychnine  in  doses  sufficient  to  put  the  whole  system 
in  tone  like  a  violin  string  in  tune.  This  may  require  but  little,  or 
enough  to  make  the  timid  therapeutist,  unaccustomed  to  dosage  for 
effect,  quake  in  his  boots.  Much  or  little,  there  is  no  danger  of  the 
remedy  if  given  as  really  needed ;  and  too  often  the  treatment  fails 
from  timidity  or  rashness.  Capsicum  is  the  best  adjuvant. 

Gastric  catarrh  and  dilatation  of  the  stomach  are  relieved  by 
small  doses  of  strychnine  continued  some  weeks,  with  carefully 
regulated  diet.  No  possible  benefit  can  accrue  from  any  medication 
if  the  patient  continues  to  distend  his  stomach  with  food  and  cold 
drinks,  etc. 

Hemorrhoids  and  other  evidences  of  an  atonic  state  of  the  large 
bowel,  are  relieved  by  moderate  doses  of  strychnine,  with  suitable 
diet  and  laxatives.  Chronic  diarrheas  and  dysenteries  continuing 
from  relaxation,  often  respond  nicely  to  a  little  strychnine. 

There  is  no  more  effective  or  speedy  heart  stimulant  than 
strychnine,  which  many  prefer  to  digitalin.  The  doses  must  be  care- 
fully regulated,  and  large  ones  in  fatty  hearts  may  kill.  In  many 
cases  an  alternation  is  advisable. 

In  cardiac  asthma  there  is  no  remedy  comparable  in  effect  to 
strychnine  arsenate,  if  given  to  full  toleration.  This  may  require  up 
to  near  a  grain  a  day ;  but  it  is  imperative  that  no  more  than  actually 
needed  be  given.  Sometimes  it  must  be  continued  for  months ;  but 
other  measures-,  diet  and  regulated  exertion,  and  climate,  should  be 
utilized  so  as  to  render  the  use  of  this  priceless  boon  as  limited  as  is 
actually  necessary.  For  the  true  physician  must  ever  distinguish 
between  temporary  improvement  and  actual  cure;  between  the 
stimulant  that  rallies  the  last  reserves,  and  the  real  increase  in  the 
vital  forces. 

And  this  last  remark  leads  us  to  speak  here  of  strychnine  as  a 
remedy  for  sexual  weakness.  It  fe  a  disaster  for  man  or  woman  to 
get  hold  of  this  bit  of  information  without  the  further  knowledge 
that  governs  and  corrects  it.  Humanity  wants  increased  sex  power, 
despite  the  notorious  fact  that  most  men  and  some  women  would 
be  the  better  for  having  a  good  deal  less.  Strychnine  cannot  bring 
back  youth,  nor  indeed  increase  the  vital  stock.  It  simply  rallies  the 


352  STRYCHNINE 

reserves,  to  be  used  wisely  by  the  very  few,  to  be  more  quickly 
wasted  by  the  foolish  many. 

Strychnine  fills  an  important  place  in  the  treatment  of  paralyses. 
When  an  apoplectic  effusion  has  occurred,  some  nerve  fibers  are 
torn  asunder,  others  are  compressed  by  the  effused  blood,  by  the 
zone  of  inflammation  surrounding  the  site  of  injury,  and  by  the  zone 
of  oedema  surrounding  that.  Recovery  from  the  compression  from 
each  goes  on  more  slowly  than  in  the  one  outside.  Some  fibers  do 
not  resume  their  functions  even  when  the  pressure  is  removed. 
Strychnine  comes  in  here,  to  arouse  the  nerves  and  restore  their 
tone.  In  the  latter  respect  it  is  better  than  electricity.  It  should  not 
be  given  till  the  first  period  is  past,  that  when  we  try  to  limit  the 
effusion ;  not  in  the  second,  when  we  are  promoting  its  resorption ; 
but  after  six  weeks  have  elapsed  we  begin  cautiously  with  small 
doses,  and  increase  cautiously  to  full  tolerance.  And  the  word 
"cautiously"  is  repeated  purposely. 

All  forms  of  paralysis  come  under  this  treatment.  Strychnine 
will  do  all  that  medicine  will,  for  these  cases. 

Mays  has  urged  strychnine  as  the  chief  remedy  for  phthisis ;  and 
as  to  its  efficacy,  when  the  alimentary  canal  has  been  rendered 
aseptic,  there  is  no  doubt.  But  we  have  not  found  in  it  specific 
virtues. 

Strychnine  has  been  used  with  benefit  in  all  forms  of  amaurosis ; 
neuralgias  of  all  descriptions,  where  full  doses  often  break  up  the 
pain  habit ;  chorea ;  epilepsy ;  etc. 

A  general  tonic,  one  that  improves  the  tone  and  increases  the 
function  of  every  tissue  and  organ  in  the  human  body,  it  would  be 
strange  indeed  if  it  were  not  abused.  We  are  now  in  the  strychnine 
epoch,  when  everyone  gets  strychnine  for  everything.  Many  a  case 
of  strychnine  habit  exists,  as  yet  unrecognized.  Many  a  case  of 
chronic  poisoning  we  fear  goes  to  the  grave  unrecognized.  The 
lazy  doctor  adds  this  to  his  morphine  and  whisky,  and  finds  he  has 
his  needs  amply  supplied ;  with  an  occasional  dose  of  salts.  Against 
this  tendency  the  best  defense  is  the  disposition  to  nicety  acquired 
through  the  use  of  the  alkaloids.  As  one  becomes  accustomed  to 
certainties  in  effects  he  needs  more  and  more  remedies  t>y  which 
exactness  of  indication  may  be  exactly  met  therapeutically. 

In  treating  the  alcohol  habit  the  nitrate  of  strychnine  has  been 

•«•"••••»•••_«__ 

preferred  to  the  other  salts.  It  is  quite  soluble  and  easily  given 
hypodermically. 

The  hypophosphite  of  strychnine  has  been    advised   when    this 


STRYCHNINE  3*3 

remedy  is  employed  as  a  reconstructive  tonic,  especially  in  the  young, 
and  when  combined  with  other  hypophosphites,  of  lime,  iron, 
quinine,  etc. 

Strychnine  arsenate  combines  the  properties  of  these  two  great 
tonics,  and  is  most  extensively  employed  when  vital  incitation  is  in- 
dicated. The  dose  as  to  strychnine  is  about  two-thirds  as  strong  as 
the  sulphate,  hence  the  granule  of  gr.  1-67  about  equals  gr.  i-ioo 
of  the  latter. 

It  has  seemed  to  the  writer  that  the  response  from  strychnine 
valerianate  came  more  promptly  than  from  any  of  the  other  salts. 
Small  as  is  the  quantity  of  valerianic  acid  in  the  dose,  it  is  not  with- 
out activity,  and  in  nervous  and  hysteric  cases,  and  when  given  as  a 
bracer,  a  restorer  of  tone  in  conditions  of  hypochondria,  neuras- 
thenia, spermatorrhea,  and  the  consequences  of  mental  overwork, 
this  salt  has  proved  eminently  satisfactory. 

In  all  but  emergencies  where  it  is  essential  to  obtain  maximal  ef- 
fects as  quickly  as  possible,  it  is  wise  to  use  very  small  doses  of 
strychnine  and  gradually  repeat  until  the  desired  tonicity  has  been 
secured.  This  avoids  all  danger  of  overdosing,  of  striking  an 
idiosyncrasy,  and  begets  in  the  physician  the  habit  of  closely  watch- 
ing his  patient's  symptoms,  which  is  not  so  universal  as  one  could 
wish.  Even  with  alcoholics  the  response  to  strychnine  may  come 
with  incredibly  small  doses ;  and  on  the  other  hand  these  people  may 
require  almost  incredible  doses  to  equalize  the  nervous  pressure  and 
restore  that  springlike  tonicity  that  does  so  much  to  encourage  him 
to  persist  in  his  reform.  Many  reformed  inebriates  emerge  from  the 
"cures"  with  the  strychnine  habit.  This  may  be  gradually  shaded 
down  into  brucine,  and  this  into  berberine;  but  even  if  not,  it  is 
surely  preferable  to  the  whisky  habit. 

During  the  past  decade  strychnine  has  come  generally  into  use  as 
a  means  of  sustaining  the  vital  forces  and  the  heart  especially,  dur- 
ing the  course  of  fevers.  In  pneumonia  it  may  be  termed  the  chief 
reliance  of  many  physicians.  This  matter  has  been  fully  discussed 
in  the  chapters  on  aconitine,  digitalin  and  veratrine,  to  which  the 
reader  is  referred.  In  all  febrile  maladies  when  there  are  any  signs 
of  adynamia  approaching,  the  rule  is  to  forestall  danger  by  adding  a 
sufficiency  of  strychnine;  and  many  a  life  has  been  saved  by  this 
wise  forethought.  But  that  does  not  mean  a  senseless  administra- 
tion of  this  powerful'  drug  where  it  is  not  needed.  There  is  a  place 
for  veratrine  as  well  as  for  strychnine. 


354  VERATRINE 

In  constipation  strychnine  is  a  useful  ingredient  of  every  really 
valuable  combination  for  the  cure  of  this  malady. 

And  yet  the  half  has  not  been  said.  Every  physician  of  wide 
experience  can  add  instances  of  the  fitness  of  this  most  powerful 
agent  for  special  conditions  not  mentioned  in  this  article. 

VERATEINE. 

Standard  granule — Gr.  1-134,  gm.  .0005. 

Of  the  veratrine  group  veratrum  viride  has  won  the  strongest 
hold  upon  the  medical  profession,  whose  confidence  in  it  has  not 
been  shaken  by  adverse  reports,  the  introduction  of  German 
synthetic  antipyretics,  or  even  the  dreadful  accusations  of  "eclec- 
ticism" and  "homeopathy."  The  alkaloidal  representative  of  the 
green  veratrum  is  generally  assumed  to  be  veratrine.  We  propose 
to  examine  this  question  and  ascertain  whether  this  substance  really 
represents  veratrum  viride  therapeutically ;  and  if  not,  whether 
either  of  the  other  bodies  extracted  from  this  group  of  plants  more 
nearly  represents  the  desirable  qualities.  For  the  galenic  prepara- 
tions- of  veratrum  viride  are  no  exceptions  to  the  rule,  that  all  plant- 
extracts,  tinctures,  etc.,  contain  their  active  principles  in  uncertain 
and  variable  quantities  and  proportions,  and  hence  are  fatally  want- 
ing in  the  scientific  precision  of  their  application  for  the  cure  of  the 
sick. 

Veratrum  viride  contains  a  little  veratrine,  pseudojervine, 
cevadine  and  veratralbine,  with  a  good  deal  of  jervine,  and  rubi- 
jervine  or  veratroidine.  To  the  latter  two  its  effects  are  mainly  at- 
tributable. 

Cevadilla  contains  veratrine,  sabadine,  cevadilline,  sabadinine 
and  Wright's  veratrine.  Of  these  veratrine  alone  has  been  studied 
carefully.  The  others  have  not  as  yet  been  shown  to  possess  any 
other  importance  than  as  weakening  the  official  veratrine  by  their 
presence  in  variable  proportions. 

Merck  lists:  i.  C.  P.  crystallized  veratrine  or  cevadine  (solu- 
ble in  alcohol  and  ether)  ;  2,  Veratrine,  U.  S.  P.,  containing  the 
other  cevadilla  alkaloids  but  in  too  small  proportion  to  affect  the 
dosage ;  3,  Veratrine  amorphous ;  4,  V.  acetate,  hydrochlorate,  ni- 
trate, sulphate  and  valerianate ;  5,  Jervine;  6,  Sabadilline,  C21  H27 
NO7,  soluble  in  alcohol,  chloroform  and  benzc/le,  and  in  143  parts 
boiling  water;  close  twelve  times  that  of  veratrine  (Urpav)  ;  7, 
Sabadilline  sulphate,  soluble  in  water  or  alcohol ;  8,  Sabadine, 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


VERATRINE  355 

Q9H51NO8>  soluble  in  water,  alcohol  or  ether,  also  its  salts ;  9,  Saba- 
dinine,  C27H45NO8,  soluble  in  water,  alcohol,  ether  or  chloroform ; 
also  the  hydrochlorate,  bisulphate  and  an  amorphous  form. 

Physiologic  Action.— Veratrine,  C32H49NO9  (C37H53NOn, 
Bruehl),  is  quite  soluble  in  hot  water  and  alcohol,  slightly  in  cold 
water.  It  is  absorbed  from  the  skin,  the  mucous  membranes  and  the 
subcutaneous  tissues.  It  is  rapidly  eliminated  by  the  kidneys,  and  also 
by  the  gastrointestinal  mucous  membrane,  the  latter  being  irritated 
by  its  passage.  When  inhaled,  veratrine  causes  dry,  irritative  and 
fatiguing  cough.  Applied  to  the  nasal  mucosa  it  causes  violent  and 
prolonged  sneezing.  Even  a  granule  containing  half  a  milligram, 
allowed  to  dissolve  in  a  child's  mouth,  has  raised  vesicles.  Applied 
to  the  unbroken  skin,  veratrine  does  not  cause  redness,  but  a  sensa- 
tion of  burning  and  prickling,  followed  by  cold  and  formication, 
with  anesthesia. 

Given  in  moderate  doses  by  the  mouth,  veratrine  increases  the 
excretion  of  urine,  perspiration  and  saliva,  and  if  continued  or  in- 
creased causes  a  sense  of  warmth  in  the  stomach,  with  burning, 
nausea,  colic,  vomiting  and  diarrhea.  Persons  unusually  suscepti- 
ble to  its  action  have  bloody  stools  and  vomit.  The  prickling  ex- 
tends over  the  entire  skin,  followed  by  anesthesia  and  free  sweat- 
ing. Van  Renterghem  took  0.0005  every  half-hour,  for  36  hours, 
without  experiencing  diarrhea,  vomiting  or  any  toxic  symptom. 

Toxic  doses  cause  dilatation  of  the  pupils. 

Veratrine  exercises  a  deleterious  effect  upon  certain  protoplasms, 
in  which  it  resembles  quinine  (Kuen  and  Scharrenbroich).  The 
lymphatics  are  thereby  rendered  less  hospitable  to  microbes ;  or  per- 
haps the  latter  are  attacked  by  the  veratrine  (Van  Renterghem). 

Absorbed  through  the  skin,  veratrine  may  cause  diuresis  instead 
of  purging  (Bardsley). 

Small  doses  quicken  the  pulse  and  respiration  and  raise  the 
blood-pressure,  but  larger  or  repeated  doses  reverse  all  these. 

The  temperature  is  lowered  from  the  start. 

At  first  the  vasomotor  centers,  the  peripheral  inhibitory  nerves 
and  medullary  centers  are  stimulated,  la.ter  they  are  paralyzed 
(Hare). 

Toxic  doses  cause  continued  weakening  of  the  heart  and  respira- 
tion, which  finally  cease  almost  simultaneously.  The  pulse  becomes 
slow  and  irregular,  breathing  slow  and  labored.  Fibrillary  con- 
tractions of  the  muscles  are  frequent,  with  convulsions,  followed  by 
collaspe,  unconsciousness  and  death  by  respiratory  failure  (Cushny). 


356  VERATRINE 

The  nausea  may  in  part  be  due  to  direct  irritation  of  the  gastric 
sensory  nerve-ends,  but  is  probably  due  in  the  main  to  central  irrita- 
tion. The  salivation  may  be  primary,  or  due  to  the  nausea.  The 
purging  is-  attributable  to  action  on  the  intestinal  nerves ;  perspira- 
tion to  stimulation  of  the  nerve-ends  regulating  secretion  of  the 
sudoriparous  glands  (Cushny). 

The  most  marked  peculiarity  of  the  action  of  veratrine,  is  its 
effect  upon  the  striated  muscular  fiber.  The  contractions  are 
strengthened  and  continuous,  relaxation  being  so  slow  that  coordina- 
tion is  impaired.  The  relaxation  occupies  20  to  30  times  the  normal 
period.  If  the  muscle  has  been  fatigued,  veratrine  causes  marked 
improvement  in  its  contractions.  This  effect  of  veratrine  is1  in  turn 
removed  by  fatigue,  or  by  severe  cold  or  heat ;  while  moderate  heat 
increases  or  prolongs  the  effect  of  the  drug  (Cushny).  Thus,  the 
febrile  temperature  alters  the  action  of  veratrine  (Brunton).  The 
heat  generated  by  exercise  is  increased  by  veratrine.  Both  the  ir- 
ritability and  the  absolute  strength  of  the  muscles  are  increased  by 
veratrine.  In  the  frog,  the  muscle  is  finally  paralyzed,  but  in  man 
the  respiratory  failure  occurs  long  before  this  is  due.  This  action 
is  peripheric,  as  it  occurs  in  muscles  that  have  been  excised.  It  is 
attributed  to  an  increase  in  the  katabolism  in  the  muscular  cells 
(Cushny). 

Applied  directly  to  the  peripheral  nerves,  their  irritability  is 
abolished  (Waller). 

The  ventricular  muscular  apparatus  in  frogs  is  affected  like  the 
striated  muscles,  but  the  auricular  fibers  much  less.  The  ventricular 
systole  is  at  first  strengthened  and  prolonged,  then  the  period  of 
contraction  is  lengthened  until  one  ventricular  rhythm  corresponds  to 
two  of  the  auricle.  Later  the  contractions  become  slower  and  weak- 
er until  they  cease.  In  this  the  action  is  analogous  to  that  of 
digitalis.  Stimulation  of  the  cardiac  inhibitory  center  slows  the 
heart,  lessening  its-  output,  the  peripheral  vessels  contracting  through 
central  vasomotor  stimulation.  With  larger  doses  the  vagus-ends 
are  paralyzed,  its  center  depressed,  the  pulse  is  faster,  the  tension 
lowered. ,  No  prolongation 'of  the  systole  is  seen,  but  a  slight  stimu- 
lation, since  maximum  doses  quicken  the  rhythm  even  after  atropine. 
Veratrine  resembles  aconitine  as  to  the  circulation,  but  without 
stimulating  the  cardiac  muscle  (Cushny).  The  heart  stops  in 
diastole  (Hare). 

Respiration :  The  action  closely  resembles  that  of  aconitine, 
death  being  by  both  caused  by  respiratory  paralysis  (Cushny). 


VERATRINE  367 

Central  Nervous  System:  Stimulated  as  by  aconitine,  large 
doses  ending  in  paralysis.  The  medulla  and  cord  are  more  affected 
than  the  cerebrum,  consciousness  ending  only  in  death. 

Temperature :  Lowered  by  slowing  of  circulation,  unless  con- 
vulsions are  marked,  when  the  temperature  is  raised. 

Veratrine  increases  reflex  excitability  (Brunton). 

The  convulsions  of  veratrine  are  always  tonic,  never  clonic  or 
epileptoid.  Tetanic  spasms  are  excited  by  the  slightest  touch  or 
breath  of  air  (Hare). 

Veratrine  lessens  oxidation  somewhat  (Brunton). 

The  peculiar  prickling  caused  by  veratrine  is  felt  in  the  fingers, 
toes  and  joints;  that  of  aconitine  in  the  tongue  (Brunton).  It 
stimulates  the  nerves  of  ordinary  sensation  and  the  pulmonary 
branches  of  the  vagus ;  the  slow  pulse  caused  by  it  being  lessened  or 
abolished  by  section  of  the  vagi.  Stimulation  of  the  vasomotor 
center  is  shpwn  by  the  rise  of  blood-pressure,  ceasing  on  section  of 
the  cord  below  the  medulla;  though  subsidiary  centers  exist  in  the 
cord  itself.  Small  doses  stimulate  the  cardiac  muscle,  causing  in- 
creased energy  of  contraction,  the  pulse  remaining  the  same  or 
slower.  Larger  doses  induce  a  following  stage  of  peristaltic  action, 
and  stoppage  in  either  systole  or  diastole  (Brunton). 

The  effect  of  veratrine  is  weakened  when  it  is  passed  through 
the  liver  (Sollmann). 

In  chronic  poisoning  the  patient  becomes  weak  and  thin,  with 
bloody  diarrhea,  insomnia  and  delirium  (Sollmann). 

OTHER  VERATRUM  ALKALOIDS. 

Jervine  is  soluble  in  alcohol  only.  It  causes  sluggishness,  pro- 
gressive muscular  weakness  and  lessened  reflexes,  violent  general 
tremors,  ending  in  convulsions,  with  violent  motion  but  loss  of 
power ;  not  tetanic,  paralysis  rapidly  supervening ;  pupils  unaffected, 
no  purging  or  vomiting,  profuse  salivation,  no  local  irritation,  con- 
sciousness continues  to  the  last,  death  from  asphyxia. 

The  convulsions  are  cerebral  and  due  to  disturbed  cerebral  cir- 
culation. The  loss  of  muscular  power  is  due  to  spinal  depression ; 
the  peripheral  nerves  and  muscles  are  unaffected.  It  is  a  direct 
depressant  of  the  respiratory  centers  and  of  the  circulation.  The 
pulse  at  first  is  slowed ;  later  is  faster.  The  blood-pressure  falls 
from  first  to  last.  The  action  is  not  affected  by  vagus  section.  Direct 
depression  of  heart-muscle  or  its  ganglia  is  caused  by  any  dose.  It 
depresses  the  vasomotor  centers. 


358  VERATRINE 

Summary :  A  powerful  depressant  of  the  heart  and  vasomotor 
centers,  also  of  the  motor  spinal  and  respiratory  centers,  with  little 
other  effect  on  the  body  (Wood). 

Veratroidine  or  rubijervine  is  more  irritant  than  jervine.  It 
usually  causes  vomiting,  sometimes  purging,  before  a  fatal  dose  is 
absorbed.  It  does  not  cause  such  severe  convulsions.  Death  oc- 
curs from  paralysis  of  the  respiratory  center.  It  resembles  jervine 
in  action  on  the  cerebrum,  cord,  peripheral  nerves  and  muscles.  The 
circulatory  effect  is  subordinate  to  that  on  the  respiration.  Toxic 
doses  cause  an  enormous  rise  in  arterial  pressure.  After  section 
of  the  vagi,  it  could  not  slow  the  pulse.  After  intoxication  with  it, 
division  of  the  vagi  caused  enormous  rapidity  of  the  pulse.  It  stim- 
ulates cardiac  inhibition  powerfully,  like  aconitine.  The  vasomotor 
centers  are  unaffected. 

Summary:  A  powerful  respiratory  poison,  at  first  slowing  the 
pulse-rate  by  stimulating  the  pneumogastrics,  but  soon,  losing  con- 
trol of  the  heart  in  powerful  respiratory  paralysis.  "The  action  of 
veratrum  viride  is  the  result  of  the  combined  influence  of  its  alka- 
loids, and  as  the  relative  proportions  of  these  differ  in  different 
rhizomes,  so  in  the  finer  details  of  its  physiologic  action  one  speci- 
men of  the  veratrum  viride  differs  from  another"  (Wood). 

Protoveratrine,  CgaH^NOn,  is  the  principal  alkaloid  of 
veratrum  album,  the  others  being  jervine,  rubijervine,  pseudojervine 
and  protoveratridine.  Locally  it  causes  less  sensory  irritation  than 
veratrine,  and  the  anesthesia  following  is  more  complete.  It  does 
not  paralyze  the  motor  nerve-ends  in  maximum  doses'.  It  shortens 
the  muscle-contractions,  which  are  higher,  the  absolute  strength  in- 
creased, but  fatigue  follows  more  quickly  than  when  the  drug  is  not 
used.  It  is  much  more  toxic  than  veratrine,  approaching  aconitine 
in  strength,  while  standing  between  it  and  veratrine  in  action. 
With  the  rubijervine,  it  renders  white  hellebore  more  irritant  to  the 
stomach  and  bowels  than  either  cevadilla  or  green  hellebore ;  but 
this  is  not  uniform,  as  some  cases  of  poisoning  were  not  marked  by 
severe  gastrointestinal  action. 

Therapeutics. — Both  Schmiedeberg  and  Liebermeister  condemn 
the  internal  use  of  veratrine ;  but  Van  Renterghem  says :  "One  should 
not  forget  that  the  rise  of  arterial  pressure  and  the  great  loss  of 
heat  by  the  skin  occasioned  by  fever,  mean  something;  for  this  in- 
crease of  intravascular  tension  does  not  necessarily  imply  an  in- 
creased oxidation  in  the  tissues,  as  has  been  claimed.  But  it  is  cer- 
tain that  the  state  of  depression  of  the  circulatory  functions  oc- 


VERATRINE  369 

casioned  by  fever  adds  a  very  serious  factor  to  the  other  causes  of 
fever  heat;  and  that  veratrine,  prudently  administered,  suppresses 
this  state  and  with  it  its  consequences.  We  possess  in  our  arsenal 
no  medicament  as  powerful,  as  sure,  as  manageable  to  combat  fever, 
especially  acute  rheumatism  and  croupous  pneumonia." 

We  have  in  this  pregnant  sentence  the  key  to  the  uses  of 
veratrine  in  febrile  conditions.  "It  is  especially  in  acute  maladies 
that  its  action  is  powerful.  Since  its  introduction  in  our  hospital 
practice,  there  has  been  no  fever  or  inflammation  that  we  could  not 
direct  to  resolution"  (Burggraeve).  "We  have  always  succeeded, 
grace  to  it,  in  producing  defervescence,  in  lowering  the  most  intense 
fever,  in  conjuring  an  imminent  inflammation,  restraining  its  de- 
velopment, or  mitigating  its  effects.  It  has  served  us  with  equal 
success  in  typhoid  fever,  puerperal  fever,  pneumonia,  the  exanthe- 
mata, etc."  (Van  Renterghem). 

A  second  indication  for  veratrine  is  found  in  its  power  of  caus- 
ing sedation  of  the  cutaneous  sensory  nerves.  Burggraeve  called  it 
"the  refresher  of  the  skin,"  and  advised  it  in  erythema,  erysipelas, 
zoster,  pemphigus,  eczema,  ecthyma,  urticaria,  phlyctenular  herpes, 
febrile  aphthae,  boils,  carbuncles  and  malignant  pustule;  in  the  lat- 
ter with  the  cautery  and  other  indicated  remedies.  Van  Renterghem 
obtained  success  from  veratrine  in  pruritic  maladies  generally.  The 
sedative  action  of  veratrine  upon  the  nervous  system  renders  it  suita- 
ble in  treating  neuralgias,  the  violent  pains  of  rheumatismal  oph- 
thalmia, and  sciatica.  The  success  following  its  use  in  alcoholic 
tremor,  typhoid  convalescence,  multiple  sclerosis  (Feris),  chorea 
(d'Oliveiro,  etc.),  and  tetanus  (Harris),  may  be  explained  by  the 
action  of  veratrine  on  striated  muscular  fiber.  Turnbull  and 
Gintrac  gave  it  in  cardiac  affections,  arthritic  and  rheumatismal,  and 
for  palpitation. 

In  eclampsia  veratrine  may  well  replace  the  tincture  of  veratrum 
viride,  which  is  the  most  trusted  remedy  of  the  profession  in  this 
dangerous  malady. 

Externally  veratrine  is  employed  in  the  form  of  an  ointment,  ap- 
plied over  the  course  of  diseased  nerves,  with  the  object  of  produc- 
ing analgesia;  in  various  neuralgias,  facial,  lumbar,  spinal  and 
coccygeal. 

The  dose  for  internal  administration  is  given  as  0.0015  to  0.005 
(gr.  1-45—1-12)  three  times  daily,  and  0.02  (gr.  y3)  per  diem.  It  is 
little  wonder  that  with  such  dosage  this  inestimable  remedy  has 
fallen  into  disuse,  and  gained  the  repute  of  a  dangerous  weapon. 


3t>o  VERATRINE 

Many  persons  may  be  found  who  cannot  take  the  smallest  of  the 
doses  named,  without  unpleasant  effects.  Except  in  eclampsia,  the 
dose  of  0.0005  (gr.  1-134)  should  never  be  exceeded;  and  this  if 
given  every  quarter  to  one  hour  until  the  desired  effect  has  been 
secured,  will  amply  meet  every  requirement.  In  every  sthenic  febrile 
attack  let  the  bowels  be  emptied  and  the  alimentary  canal  rendered 
aseptic;  then  administer  veratrine,  0.0005,  alone  or  with  digitalin 
and  aconitine,  or  whatever  else  is  indicated.  The  speedy  solubility 
of  veratrine,  its  rapid  elimination,  and  its  power  of  unlocking  every 
channel  of  elimination  from  the  body,  even  when  closed  by  disease 
that  renders  ordinary  medication  perilous,  places  this  remedy  in 
advance  of  every  other.  In  cirrhotic  kidney,  when  l/%  grain  of 
morphine  or  one  grain  of  calomel  may  cause  death,  veratrine  not 
only  provides  for  its  own  elimination  but  renders  the  administration 
of  other  remedies  safe.  In  eclampsia  alone  should  the  dose  be  ex- 
ceeded. Here  the  local  irritation  following  the  hypodermic  applica- 
tion of  veratrine  must  be  disregarded,  and  0.005  (gr-  1-12)  given  at 
once,  in  diluted  alcohol,  to  powerfully  stimulate  elimination,  and 
save  the  brain  from  the  imminent  peril  threatening  it.  In  other 
forms  of  uremia,  in  diabetic  and  icteric  coma,  the  same  administra- 
tion should  be  employed,  with  due  watchfulness.  True,  the  heart's 
force  must  be  kept  up,  but  that  matters  little  if  the  brain  is  over- 
whelmed by  toxins.  Veratrine  and  the  normal  saline  solution  meet 
the  need  better  than  any  other  known  remedies. 

Given  internally  in  the  doses  recommended  (0.0005  every  quarter 
to  one  hour),  veratrine  should  be  continued  until  the  first  faint  in- 
timation of  nausea  is  manifested ;  then  withheld  until  this  has  disap- 
peared, or  until  again  indicated  by  the  symptoms.  If  the  stomach 
develops  an  idiosyncrasy  against  veratrine,  codeine,  0.005,  may  be 
administered  with  a  few  doses,,  provided  the  pulse  and  fever  show 
the  antipyretic  is  still  needed.  When  one  has  utilized  veratrine,  in 
this  strictly  scientific  method  of  administration,  for  several  years, 
and  become  thoroughly  familiar  with  its  properties,  its  tremendous 
power,  its  safety,  its  perfect  manageableness,  he  can  only  hear  with 
amazement  the  condemnation  of  this  alkaloid  by  men  who  have 
good  repute  as  therapeutists. 

Externally  an  ointment  of  veratrine,  0.2 — 0.5  to  25  grams  of  any 
desired  base,  may  be  employed. 

Synergists. — Aconitine  as  a  defervescent,  antiphlogistic  and  anti- 
neuralgic.  Cicutine,  curarine  and  digitalin,  as  to  the  action  on 
striated  muscle  fiber,  on  the  motor  nerve-ends  and  on  the  heart- 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


VERATRINE  361 

muscle.  Quinine  and  strychnine  for  the  action  upon  protoplasm. 
Colchicine  has  a  similar  action  on  the  sensory  nerve-ends,  but  in 
other  respects  departs  too  widely  to  be  ranged  in  the  same  classi. 

Antagonists. — The  strychnine  group  against  the  respiratory  and 
vasomotor  paralysis,  the  debility  and  vital  depression.  Codeine 
sedates  the  gastric  irritability,  lowers  topical  irritation,  and  renders 
veratrine  better  tolerated. 

Chemical  antidotes:     Tannic  acid,  iodine,  potassium  iodide. 

Physiologic  antidotes :     Stimulants,  coffee,  heat,  rest. 

"When  true  sthenic  arterial  excitement  is  to  be  combated  in 
any  disease,  except  gastritis,  veratrum  viride  may  be  employed  as  a 
prompt,  thoroughly  efficient  and  at  the  same  time  very  safe  remedy 
— very  safe,  since  it  is  almost  incapable  of  producing  death  in  the 
robust  adult.  In  the  early  stages  of  sthenic  pneumonia,  it  offers,  we 
believe,  the  best  known  method  of  reducing  the  pulse-rate  and  the 
temperature,  and  of  lessening  the  congestion. 

"In  chronic  cardiac  diseases  it  may  be  used  in  precisely  those 
cases  in  which  digitalis  is  contraindicated — i.  e.,  when  there  is  ex- 
cessive hypertrophy.  Over-doses  provoke  vomiting,  so  soon  and  so 
certainly  that  it  is  doubtful  whether  a  robust  adult  could  be  killed 
by  a  single  dose"  (Wood). 

Veratrum  viride  is  the  safest  and  best  circulatory  depressant  that 
we  have  for  use  in  adults.  "The  physiologic  action  is  to  be  con- 
sidered under  the  effects  of  its  two  alkaloids"  (Wood). 

Shoemaker  recommends  veratrine  ointments  for  neuralgia, 
myalgia,  zoster  and  infantile  paralysis;  chronic  arthritis  and  acute 
gouty  attacks;  in  pleurodynia,  chronic  pleurisy,  alopecia  circum- 
scripta,  chloasma  and  pediculosis.  The  officinal  ointment  is  two  or 
more  times  too  strong. 

Veratrum  viride  Shoemaker  advises  in  aneurism,  exophthalmic 
goiter,  early  stages  of  pneumonia  and  acute  visceral  congestions; 
acute  hemorrhage  and  mania,  in  plethora,  in  typhoid  only  with  hy- 
perpyrexia  and  active  delirium,  in  tonsillitis,  and  to  moderate 
traumatic  abdominal  inflammations.  Phillips  gave  it  for  obstinate 

priapism. 

Ringer  says  it  is  given  for  congestive  headaches  at  the  men- 
strual period. 

Ringer  applied  the  ointment  for  sick  headache,  when  accom- 
panied or  followed  by  tenderness  of  the  skin. 

Turnbull  found  the  ointment  sometimes  relieve  rheumatic  joints ; 
also  applied  it  over  ailing  hearts,  with  rapid  irregular  pulse,  hurried 


364  VIBURNIN 

menorrhea  with  excessive  flow,  malarial  menorrhagia,  uterine 
hemorrhage  near  the  menopause,  and  anemic  amenorrhea,  are  quite 
markedly  influenced  by  viburnum.  Muscular  cramps  during  preg- 
nancy are  relieved  by  it.  It  is  almost  specific  for  cramps  in  the 
legs,  occurring  especially  at  night.  It  is  the  most  reliable  and 
prompt  agent  in  the  materia  medica  to  check- .threatened  abortion, 
if  given  before  the  membranes  are  broken. 

In  habitual  abortion  small  doses  should  be  administered  a  long 
time  before  the  expected  occurrence.  Phares  who  introduced 
viburnum  claimed  that  it  would  completely  neutralize  the  effects  of 
gossypium  when  the  latter  had  been  taken  to  cause  abortion.  In 
postpartum  hemorrhage  it  is  less  effective  than  ergot  or  cinnamon. 
It  assists  in  reducing  the  subinvoluted  womb.  Viburnum  has  been 
utilized  for  various  neuroses,  chorea,  hysteria,  hystero-epilepsy, 
petit  mal,  and  paralysis  agitans.  It  is  said  to  be  of  value  in  sterility, 
spermatorrhea,  ovarian  irritation,  and  to  control  false  pains  and 
after-pains,  almost  equal  to  cimicifuga. 

Howe  employed  black  haw  for  dysmenorrhea,  leucorrhea,  pelvic 
discomforts,  and  chlorosis  and  the  debility  of  the  second  climacteric. 
For  the  user  of  alcohol  his  cordial  allayed  the  gnawing  in  the 
stomach  and  the  pharyngeal  irritation. 

Specific  indications. — Uterine  irritability  and  hyperesthesia ; 
threatened  abortion ;  uterine  colic,  dysmenorrhea  with  deficient 
menses,  severe  lumbar  and  bearing  down  pains,  cramp-like  expul- 
sive menstrual  pains ;  intermittent  painful  contractions  of  the  pelvic 
tissues ;  after-pains  and  false  pains  of  pregnancy ;  obstinate  hic- 
cough. 

Viburnin  is  one  of  the  native  plant-remedies  that  came  like  a 
revelation  upon  that  part  of  the  medical  profession  that  had  had 
little  or  no  experience  with  the  therapeutic  treasures  of  our  own 
land.  Like  veratrum  and  many  others  its  introduction  was  under 
commercial  influences,  and  yet  it  has  won  a  large  place  in  the  prac- 
tice of  the  profession.  Its  chief  field  is  as  a  preventive  of  abortion, 
and  here  its  influence  has  been  well  established.  It  cannot  stop  an 
abortion  that  has  already  occurred ;  nor  should  it  be  relied  upon  to 
the  exclusion  of  accessory  treatment,  such  as  rest  in  bed,  the  avoid- 
ance of  excitement  and  the  quieting  of  apprehension,  etc.  The 
writer  has  employed  viburnin  and  potassium  bromide  each  in  many 
cases,  and  considers  the  effects  of  the  former  better  and  more  effec- 
tive in  every  respect. 

The  dose  of  viburnin  to  stop  a  threatened  abortion  is  from  half 


XANTHOXYLIN  365 

to  one  grain,  repeated  every  half  -hour  till  effect.  The  recumbent 
position  must  be  rigidly  maintained;  the  patient  being  forbidden  to 
rise  even  to  evacuate  the  bowels  or  bladder.  After  the  pains  have 
stopped  the  remedy  should  be  continued  at  longer  intervals,  and 
generally  for  months  or  till  the  end  of  pregnancy  in  doses  of  a  grain 
three  times  a  day. 

XANTHOXYLIN. 

Standard  granule — Gr.  1-6,  gm.  .01. 

Xanthoxylin  is  a  concentration  from  Xanthoxylum  fraxineum  or 
Americanum,  the  prickly  ash.  An  alkaloid  has  been  found  in  the 
bark  closely  resembling  berberine,  and  probably  identical  with  it. 
This  alkaloid  has  been  identified  in  some  xanthoxylum  barks  from 
South  America.  The  other  alkaloids  and  other  principles  in  prickly 
ash  have  not  been  studied. 

Felter  and  Lloyd  find  in  prickly  ash  many  virtues.  It  acts  upon 
the  secretions,  the  nervous  and  circulatory  systems.  It  has  remark- 
able powers  as  a  sialagog,  causes  warmth  in  the  stomach  and  pro- 
motes the  flow  of  gastric  and  intestinal  secretions.  The  bile  and 
pancreatic  action  is  also  stimulated,  the  urine  increased.  The  pulse 
is  a  little  hastened,  the  skin  acts  abundantly.  It  is  especially  a 
stimulant  of  the  sweat  glands  and  the  mucous  secretions. 

It  is  also  emmenagog  and  carminative,  and  the  berries  antiseptic. 
It  has  been  given  for  rheumatic  complaints,  with  phytolacca;  as  an 
eliminant  for  debilitated  patients ;  but  the  cases  described  are  really 
myalgic — lumbago,  torticollis,  and  muscular  rheumatism.  In 
toothache  it  is  useful  when  there  is  dull  pain  from  peridentitis.  As 
an  eliminant  it  is  useful  in  syphilis  and  scrofula;  in  small  and  fre- 
qflent  doses.  It  has  been  employed  as  a  local  remedy  in  glottic 
paralysis;  neuralgias  and  paretic  conditions  of  the  larynx  and 
pharynx.  This  points  to  glosso-pharyngeal  paralysis,  but  we  doubt 
the  efficacy  of  any  remedy  here.  But  in  pharyngitis  and  post-nasal 
catarrhs  with  dry  glazed  mucous  surfaces  it  probably  does  good. 
As  a  gastrointestinal  tonic  xanthoxylum  is  of  use  in  atonic  dys- 
pepsia, gastric  catarrh,  costiveness,  flatulence,  jaundice  from  biliary 
catarrh  or  from  malaria,  spasm  of  the  bowels,  colic,  cholera  in- 
fantum,  and  cholera  morbus.  It  is  useful  after  dysenteries,  and  as 
a  remedy  for  epidemic  dysenteries.  King  used  the  berries  for 
Asiatic  cholera.  He  valued  it  highly  in  atonic  diarrheas  and  typhoid 
conditions,  and  the  tympanites  of  choleraic  maladies.  With 


364  VIBURNIN 

menorrhea  with  excessive  flow,  malarial  menorrhagia,  uterine 
hemorrhage  near  the  menopause,  and  anemic  amenorrhea,  are  quite 
markedly  influenced  by  viburnum.  Muscular  cramps  during  preg- 
nancy are  relieved  by  it.  It  is  almost  specific  for  cramps  in  the 
legs,  occurring  especially  at  night.  It  is  the  most  reliable  and 
prompt  agent  in  the  materia  medica  to  chfick-ihreatened  abortion, 
if  given  before  the  membranes  are  broken. 

In  habitual  abortion  small  doses  should  be  administered  a  long 
time  before  the  expected  occurrence.  Phares  who  introduced 
viburnum  claimed  that  it  would  completely  neutralize  the  effects  of 
gossypium  when  the  latter  had  been  taken  to  cause  abortion.  In 
postpartum  hemorrhage  it  is  less  effective  than  ergot  or  cinnamon. 
It  assists  in  reducing  the  subinvoluted  womb.  Viburnum  has  been 
utilized  for  various  neuroses,  chorea,  hysteria,  hystero-epilepsy, 
petit  mal,  and  paralysis  agitans.  It  is  said  to  be  of  value  in  sterility, 
spermatorrhea,  ovarian  irritation,  and  to  control  false  pains  and 
after-pains,  almost  equal  to  cimicifuga. 

Howe  employed  black  haw  for  dysmenorrhea,  leucorrhea,  pelvic 
discomforts,  and  chlorosis  and  the  debility  of  the  second  climacteric. 
For  the  user  of  alcohol  his  cordial  allayed  the  gnawing  in  the 
stomach  and  the  pharyngeal  irritation. 

Specific  indications. — Uterine  irritability  and  hyperesthesia ; 
threatened  abortion ;  uterine  colic,  dysmenorrhea  with  deficient 
menses,  severe  lumbar  and  bearing  down  pains,  cramp-like  expul- 
sive menstrual  pains ;  intermittent  painful  contractions  of  the  pelvic 
tissues;  after-pains  and  false  pains  of  pregnancy;  obstinate  hic- 
cough. 

Viburnin  is  one  of  the  native  plant-remedies  that  came  like  a 
revelation  upon  that  part  of  the  medical  profession  that  had  had 
little  or  no  experience  with  the  therapeutic  treasures  of  our  own 
land.  Like  veratrum  and  many  others  its  introduction  was  under 
commercial  influences,  and  yet  it  has  won  a  large  place  in  the  prac- 
tice of  the  profession.  Its  chief  field  is  as  a  preventive  of  abortion, 
and  here  its  influence  has  been  well  established.  It  cannot  stop  an 
abortion  that  has  already  occurred ;  nor  should  it  be  relied  upon  to 
the  exclusion  of  accessory  treatment,  such  as  rest  in  bed,  the  avoid- 
ance of  excitement  and  the  quieting  of  apprehension,  etc.  The 
writer  has  employed  viburnin  and  potassium  bromide  each  in  many 
cases,  and  considers  the  effects  of  the  former  better  and  more  effec- 
tive in  every  respect. 

The  dose  of  viburnin  to  stop  a  threatened  abortion  is  from  half 


XANTHOXYLIN  365 

to  one  grain,  repeated  every  half  "hour  till  effect.  The  recumbent 
position  must  be  rigidly  maintained;  the  patient  being  forbidden  to 
rise  even  to  evacuate  the  bowels  or  bladder.  After  the  pains  have 
stopped  the  remedy  should  be  continued  at  longer  intervals,  and 
generally  for  months  or  till  the  end  of  pregnancy  in  doses  of  a  grain 
three  times  a  day. 

XANTHOXYLIN. 

Standard  granule — Gr.  1-6,  gm.  .01. 

Xanthoxylin  is  a  concentration  from  Xanthoxylum  fraxineum  or 
Americanum,  the  prickly  ash.  An  alkaloid  has  been  found  in  the 
bark  closely  resembling  berberine,  and  probably  identical  with  it. 
This  alkaloid  has  been  identified  in  some  xanthoxylum  barks  from 
South  America.  The  other  alkaloids  and  other  principles  in  prickly 
ash  have  not  been  studied. 

Felter  and  Lloyd  find  in  prickly  ash  many  virtues.  It  acts  upon 
the  secretions,  the  nervous  and  circulatory  systems.  It  has  remark- 
able powers  as  a  sialagog,  causes  warmth  in  the  stomach  and  pro- 
motes the  flow  of  gastric  and  intestinal  secretions.  The  bile  and 
pancreatic  action  is  also  stimulated,  the  urine  increased.  The  pulse 
is  a  little  hastened,  the  skin  acts  abundantly.  It  is  especially  a 
stimulant  of  the  sweat  glands  and  the  mucous  secretions. 

It  is  also  emmenagog  and  carminative,  and  the  berries  antiseptic. 
It  has  been  given  for  rheumatic  complaints,  with  phytolacca ;  as  an 
eliminant  for  debilitated  patients ;  but  the  cases  described  are  really 
myalgic — lumbago,  torticollis,  and  muscular  rheumatism.  In 
toothache  it  is  useful  when  there  is  dull  pain  from  peridentitis.  As 
an  eliminant  it  is  useful  in  syphilis  and  scrofula ;  in  small  and  fre- 
qftent  doses.  It  has  been  employed  as  a  local  remedy  in  glottic 
paralysis;  neuralgias  and  paretic  conditions  of  the  larynx  and 
pharynx.  This  points  to  glosso-pharyngeal  paralysis,  but  we  doubt 
the  efficacy  of  any  remedy  here.  But  in  pharyngitis  and  post-nasal 
catarrhs  with  dry  glazed  mucous  surfaces  it  probably  does  good. 
As  a  gastrointestinal  tonic  xanthoxylum  is  of  use  in  atonic  dys- 
pepsia, gastric  catarrh,  costiveness,  flatulence,  jaundice  from  biliary 
catarrh  or  from  malaria,  spasm  of  the  bowels,  colic,  cholera  in- 
fantum,  and  cholera  morbus.  It  is  useful  after  dysenteries,  and  as 
a  remedy  for  epidemic  dysenteries.  King  used  the  berries  for 
Asiatic  cholera.  He  valued  it  highly  in  atonic  diarrheas  and  typhoid 
conditions,  and  the  tympanites  of  choleraic  maladies.  With 


366  YOHIMBINE 

diuretics  and  tonics  it  has  good  repute  in  dropsies,  malaria,  and 
functional  dysmenorrhea. 

As  a  nerve  stimulant  it  is  given  for  all  forms  of  nervous  pros- 
tration, hemiplegia,  locomotor  ataxia,  and  all  forms  of  vital  depres- 
sion. It  relieves  pains  down  the  front  of  the  thighs,  after-pains 
with  dorsal  or  sacral  pains,  neuralgic  pains  in  anemic  and  delicate 
persons.  By  overcoming  capillary  stasis  it  sends  to  the  surface  the 
rashes  of  the  eruptive  fevers,  especially  if  retrocedent. 

Specific  indications. — In  small  doses,  for  hypersecretion  from  de- 
bility and  mucous  relaxation ;  in  large  doses  for  nerve  atony,  capil- 
lary engorgement  in  exanthemata,  sluggish  circulation,  tympanites, 
gastrointestinal  torpor  with  deficient  secretion ;  dry  mucosa  of 
mouth  and  fauces  with  glazed  glossy  surfaces,  flatulent  colic, 
Asiatic  cholera,  uterine  cramps,  and  neuralgia ;  for  painful  bowel 
troubles  the  berries  are  preferred  to  the  bark. 

While  the  eclectics  make  a  distinction  between  the  uses  of  the 
bark  and  those  of  the  berries,  they  give  no  data  as  to  a  difference  in 
chemistry,  nor  do  their  accounts  seem  to  show  why  there  should  be 
the  difference  in  application.  They  term  the  bark  stimulant,  tonic, 
alterative  and  sialagog,  while  the  berries  are  stimulant,  carminative 
and  antispasmodic,  acting  specially  on  mucous  tissues.  The  bark 
is  also  said  to  be  especially  stimulant  to  the  mucous  surfaces.  If 
there  is  any  difference  it  would  seem  likely  that  the  berries  contain  a 
carminative  volatile  oil  in  addition  to  the  special  stimulant  of 
mucous  secretion  which  is  present  in  both  parts  of  the  plant.  And 
to  the  latter  the  specific  virtues  of  xanthoxylin  are  to  be  attributed. 
An  agent  that  will  stimulate  the  mucous  secretions  throughout  the 
body,  without  nauseating  or  depressing  like  emetine  or  lobelin,  is 
of  considerable  interest,  and  should  receive  numerous  applications. 
It  should  be  a  good  addition  to  prescriptions  for  habitual  constipation 
when  costiveness  is  a  feature ;  and  for  the  whole  line  of  dry  catarrhs. 
If  the  principle  to  which  this  effect  is  due  can  be  isolated  it  might 
prove  useful  as  a  local  application  in  nasal  catarrhs  of  this  description. 

The  dose  of  xanthoxylin  is  gr.  1-6  every  one  to  two  hours,  until 
the  effect  is  manifest,  then  less  frequent.  In  chronic  cases  and 
for  costiveness  the  dose  may  be  placed  at  a  grain  four  times  a  day. 

YOHIMBINE. 

Standard  granule — Gr.  1-12,  gm.  .005. 

Yohimbine  is  an  alkaloid,  C23H49N2O4.  For  rabbits  the  toxic 
dose  is  o.on  intravenously  and  0.053  subcutaneously,  per  kilogram 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


YOHIMBINE  357 

of  body-weight.  In  frogs  it  inhibits  the  heart-action,  stopping  it  in 
diastole,  and  paralyzes  respiration.  The  vascular  tension  is  relaxed, 
the  pulse-rate  being  unaffected.  In  warm-blooded  animals  small 
doses  cause  unrest,  excitement  and  erections,  and  large  doses  cause 
violent  spasms,  followed  by  weakness.  It  paralyzes  the  motor  centers 
but  not  the  sensory.  Oberwarth  showed  that  the  aphrodisiac  effects 
are  exerted  upon  the  nerve  centers.  Bartholow  suggests  that  it  may 
prove  useful  in  albuminuria,  by  substitution. 

As  reports  accumulate  upon  the  use  of  yohimbine  as  an  aphro- 
disiac, its  true  action  is  becoming  defined  and  its  place  in  thera- 
peutics fixed.  The  hydrochlorate  is  the  form  in  which  it  is  best 
prescribed,  as  this  is  comparatively  stable,  while  pure  yohimbine 
alkaloid  is  altered  by  the  action  of  air  and  light. 

Yohimbine  is  sharply  differentiated  in  its  effects.  It  produces 
hyperemia  of  the  penis  and  testicles,  in  a  short  time  after  its  ex- 
hibition. Repeated  for  a  considerable  period,  no  ill-effects  were 
noted,  and  no  degenerative  change  could  be  discovered  on  post- 
mortem. In  locomotor  ataxia  and  other  organic  disease  no  ill  effect 
followed  the  use  of  this  drug.  In  neurasthenia  and  nervous  erethism 
marked  benefit  was  obtained  from  it.  Sometimes  the  benefit  was 
immediate,  but  in  other  cases  several  weeks  were  required  to  obtain 
the  good  effects.  Pains  have  been  taken  to  exclude  the  influence 
of  suggestion.  Berger  gave  three  times  the  usual  dose,  or  .015 
grams  thrice  daily,  in  some  cases,  before  the  desired  effect  was 
manifested.  No  ill  effects  followed  these  doses.  He  suggests  that 
if  the  effect  wears  off  the  drug  should  be  discontinued  for  a  time ; 
but  those  who  have  tested  the  drug  most  carefully  do  not  agree 
with  this. 

In  one  case  it  seemed  to  stir  up  an  old  orchitis.  In  another,  a 
lady  normal  anatomically  but  devoid  of  sexual  desire  or  sensation, 
the  only  effect  from  yohimbine  was  prolongation  of  menstruation. 

Yohimbine  may  be  given  by  the  stomach  or  hypodermically.  For 
hypodermic  use  the  hydrochlorate  must  be  dissolved  in  boiling  wa- 
ter. This  solution  will  keep  for  a  few  weeks,  and  longer  if  a  drop 
of  chloroform  is  added.  It  is  advised  to  give  the  tablets  containing 
.005  each,  three  times  a  day,  for  six  weeks  or  more,  rather  than  to 
give  larger  doses. 

It  is  quite  evident  from  the  accounts  that  yohimbine  is  strictly 
limited  in  aphrodisiac  effect  to  the  stimulation  of  erection  and  pro- 
ducing congestion  of  the  testes ;  with,  inferentially,  an  increase  in 
their  secretion,  though  this  is  not  stated  by  any  paper  on  this  dm?: 


368  ZINC  CYANIDE 

we  have  yet  read.  But  it  is  absolutely  devoid  of  any  power  to 
arouse  or  increase  sexual  desire.  It  is  not  a  drug  to  aid  the  seducer. 
When  desire  i&  present  but  erection  imperfect  or  absent,  yohimbine 
is  the  remedy  indicated.  This  condition  as  caused  by  dilation  of  the 
penile  veins,  seems  unknown  to  the  Germans,  and  some  of  the  fail- 
ures recorded  from  yohimbine  may  be  due  to  this  condition.  If  so 
it  is  quite  explicable  that  an  agent  relaxing  vascular  tension  would 
not  give  relief. 

Dr.  J.  Rutter  Williamson  records  three  cases  in  which  he  ad- 
ministered yohimbine  with  the  desired  result.  One  of  his  patients 
was  a  young  man  who,  through  nervousness  and  want  of  erectile 
power,  had  failed  to  consummate  the  marriage  act  during  the  entire 
two  years  of  his  wedded  life. 

Medication  with  strychnine,  caffeine,  damiana,  cantharides  and 
capsicum  had  proven  fruitless*.  Three  lo-milligramme  doses  of 
yohimbine  brought  about  a  restoration  to  normal  function. 

The  two  other  cases  were  almost  identical  with  the  above-de- 
scribed one,  except  that  the  impotence  had  been  of  briefer  duration 
and  responded  to  doses  of  half  the  amount  (5  milligrammes). 

The  high  price  at  which  yohimbine  is  held  ($1.00  a  grain)  will 
limit  its  use  for  a  time ;  but  if  it  acquires  a  permanent  place  in  thera- 
peutics the  price  will  undoubtedly  subside. 

ZINC  CYANIDE. 

Standard  granules — Gr.  1-67,  gm.  .001 ;  gr.  1-6,  gm.  .01. 

The  cyanide  of  zinc  represents  therapeutically  hydrocyanic  acid 
and  the  preparations  depending  on  this  potent  agent  for  their  thera- 
peutic value.  Not  one  of  these  is  trustworthy,  uniform  or  safe  in 
its  applications.  The  writer  has  purchased  the  dilute  acid,  U.  S.  P., 
from  the  greatest  manufacturers  in  the  country  and  found  it  ab- 
solutely inert,  in  teaspoonful  doses.  He  has  tried  to  use  potassium 
cyanide,  bitter  oil  of  almonds,  etc.,  and  the  liquor  known  as  noyau, 
the  latter  being  the  most  satisfactory  of  all ;  but  he  had  to  give  up 
the  use  of  this  agent  as  none  of  these  proved  sufficiently  uniform  in 
activity  to  be  fairly  safe.  Zinc  cyanide  has  proved  all  that  could  be 
asked  in  these  respects,  uniformly  active  and  not  subject  to  decom- 
position like  the  potassium  salt. 

Zinc  cyanide  is  odorless  and  tasteless,  insoluble  in  water  and  in 
alcohol,  soluble  in  caustic  alkalies  and  in  ammonia.  Strong  mineral 
acids  decompose  it,  setting  free  the  hydrocyanic  acid. 


ZINC  CYANIDE  369 

Henning  employed  this  salt  as  a  substitute  for  hydrocyanic  acid, 
and  found  it  satisfactory.  It  also  exerted  a  vermifuge  effect.  In 
the  nervous  affection  termed  cramp  of  the  stomach  he  gave  gr.  J4 
with  magnesia  and  cinnamon  every  four  hours.  It  has  been  recom- 
mended in  chorea,  epilepsy,  and  other  neuroses.  In  neuralgia,  espe- 
cially of  the  fifth  nerve,  it  appears  to  be  of  value ;  and  in  neuroses 
of  the  heart  with  arrhythmia,  pain  and  palpitation,  doses  of  gr.  l/$ 
every  hour  or  two  have  been  advised. 

The  double  cyanide  of  zinc  and  potassium  has  the  advantage  of 
being  freely  soluble  in  water.  The  dose  is  the  same  as  of  the  pre- 
ceding. 

In  the  stomach,  however,  zinc  cyanide  is  decomposed  by  the  acid 
of  the  gastric  juice,  setting  free  the  hydrocyanic  acid.  Given  in  too 
large  doses  the  chloride  of  zinc  formed  will  irritate  the  stomach. 
The  effects  of  glonoin  so  closely  resemble  those  of  the  cyanides  that 
they  should  be  considered  synergistic. 

Hydrocyanic  acid  occurs  in  the  seeds  of  the  apple,  cherry, 
prune,  plum,  peach  and  apricot ;  and  especially  in  the  bitter  almond. 

Kirschwasser  and  maraschino,  as  well  as  noyau,  contain  this 
acid.  Laurel  water  and  wild  cherry  contain  the  acid  in  very  small 
quantities.  The  action  of  the  acid  and  of  its  single  salts  is  identical, 
but  the  double  cyanides  are  mostly  inert — or  at  least  harmless. 

Physiologic  Action. — Hydrocyanic  acid  is  a  protoplasmic  poison, 
first  stimulating  and  then  paralyzing  the  central  nervous  system. 
Cushny  places  the  fatal  dose  for  man  at  gr.  i — il/2  of  the  pure  acid. 
It  acts  with  the  greatest  rapidity.  After  very  large  doses  there  may 
be  no  symptoms — the  animal  falls  with  a  slight  convulsion  or  a 
scream,  and  death  ensues  in  a  few  moments  from  paralysis  of  the 
heart  and  respiration.  In  small  doses  it  has  a  bitter  acrid  burning 
taste,  with  salivation,  followed  by  numbness  in  the  mouth  and 
throat.  Warmth  in  the  stomach  is  followed  by  nausea,  vomiting, 
mental  confusion,  headache,  dyspnea,  slow  pulse,  and  general  mus- 
cular weakness.  The  pupils  dilate  widely  and  the  eyeballs  protrude. 
Unconsciousness  follows,  then  convulsions,  passing  into  paralysis, 
the  bladder  and  bowels  opening  involuntarily.  Respiration  weakens 
and  ceases,  the  heart  continuing  to  beat  for  some  time  longer.  The 
action  seems  to  develop  in  the  medulla  and  basal  parts  of  the  brain 
rather  than  in  the  cortex.  Some  local  anesthesia  is  caused. 

Small  doses  quicken  and  deepen  respiration.  The  pulse  is 
slowed  by  stimulation  of  inhibition,  and  the  pressure  rises  from  vaso- 
constrictor central  stimulation.  Paralysis  of  both  follows  from  in- 


3YO  ZINC  CYANIDE 

creased  doses,  but  as  the  cardiac  muscles  is  directly  affected  the 
pulse  remains  slow.  The  movements  of  the  stomach  are  lessened; 
the  temperature  rises  a  little  after  small  doses,  falls  fast  after  toxic 
doses  (Cushny). 

Geppert  found  that  prussic  acid  lessened  the  absorption  of 
oxygen  by  the  tissues,  and  less  carbonic  acid  was  excreted. 
Oxyhemoglobin  not  being  reduced  in  the  capillaries,  the  venous  blood 
was  as  red  as  the  arterial.  The  acid  is  rapidly  decomposed  in  the 
blood,  so  that  the  symptoms  are  of  brief  duration.  The  acid  is 
changed  to  sulphocyanides  in  the  tissues,  and  is  partly  excreted 
through  the  kidneys  in  that  form.  Part  undergoes  other  changes, 
whose  nature  is  unknown. 

Therapeutics. — Zinc  cyanide  may  be  prescribed  to  meet  symp- 
toms resulting  from  increased  sensibility  of  the  cerebrospinal  sys- 
tem, and  excitement  of  the  heart.  It  may  soothe  intense  pains,  calm 
exalted  sensibility,  and  prevent  reflex  spasms.  In  laryngitis  and 
acute  respiratory  inflammations  Van  Renterghem  associates  it  with 
aconitine,  digitalin  and  strychnine;  in  spasmodic  and  painful  affec- 
tions of  the  air  passages  and  abdominal  organs,  in  convulsive  cough 
and  that  of  phthisis,  cardialgia,  colic  and  vomiting;  and  in  the 
chronic  nervous  maladies,  epilepsy,  chorea,  hypochondria  and 
hysteria,  he  finds  the  field  for  this  agent.  In  organic  diseases  of  the 
heart  and  great  vessels  it  calms  over-action;  applied  locally  it  re- 
lieves pain  and  itching. 

In  acute  cases  it  is  wise  to  give  cautiously  at  first,  a  granule  gr. 
1-67  every  hour  or  two,  until  the  susceptibility  is  ascertained,  of 
children.  But  to  adults  this  dose  may  be  given  every  quarter-hour, 
or  doubled.  In  cardialgias  we  may  add  strychnine  or  hyoscyamine ; 
after  having  emptied  the  bowels ;  in  heart  cases  join  to  digitalin,  the 
arsenates,  and  care  for  the  doses,  which  may  be  a  granule  or  two 
four  or  five  times  a  day;  in  the  neuroses  veratrine,  cicutine,  arse- 
nates,  atropine,  strychnine,  bromides,  or  other  remedies  as  may  be 
indicated. 

It  is  always  better  to  use  the  smaller  dose,  and  multiply  the 
doses,  as  the  drug  is  quickly  decomposed  or  eliminated ;  and  thus 
the  irritation  of  the  stomach  is  avoided.  In  many  of  its  uses  glonoin 
has  perhaps  replaced  the  cyanides,  but  the  latter  relieves  irritative 
cough  and  nausea,  which  the  former  does  not  do.  In  the  cough  of 
phthisis  especially,  the  use  of  zinc  cyanide  enables  us  to  dispense 
with  opiates  for  a  long  time.  Here  the  action  of  the  zinc  on  the 
stomach  is  usually  beneficial  as  it  acts  as  an  antiseptic,  and  this 
action  is  needed. 


ZINC  OXIDE.     ZINC   PHOSPHIDE  371 

ZINC  OXIDE. 

Standard  granule — Gr.  1-6,  gm.  .01. 

Zinc  oxide  being  insoluble  is  less  apt  to  irritate  the  stomach  than 
the  chloride,  or  even  the  sulphate.  In  small  doses  the  oxide  soothes 
irritation  of  the  stomach,  allays  nausea,  checks  diarrhea,  and  tends 
to  restore  a  chronically  catarrhal  mucous  membrane  to  its  normal 
state.  A  specialist  of  very  great  experience  stated  to  the  writer  that 
he  considered  the  curative  effects  of  zinc  oxide  superior  to  those  of 
all  the  other  metallic  salts  in  use. 

Zinc  is  excreted  in  the  bile  and  the  urine,  and  by  the  walls  of  the 
stomach  and  bowels.  Its  continued  action  or  exposure  to  its  fumes 
as  in  those  working  with  it,  results  in  a  condition  of  chronic  poison- 
ing, characterized  by  malaise,  weakness,  vague  pains,  rigors,  fast 
pulse,  cough,  soreness  in  the  thorax,  and  headache.  Profuse  sweat- 
ing occurs,  followed  by  sleep.  These  attacks  recur  frequently. 

Therapeutics. — Zinc  oxide  has  been  given  for  epilepsy,  chorea, 
hysteria  and  a  variety  of  neuroses,  with  considerable  benefit.  It  is 
one  of  the  most  reliable  remedies  for  gastric  ulcer,  and  especially  as 
following  the  oxide  of  silver  when  the  latter  must  be  discontinued  to 
avoid  argyria.  It  has  been  advised  in  whooping-cough,  catalepsy, 
neuralgia,  and  gastrodynia.  It  is  decidedly  useful  in  the  gastric 
and  nervous  symptoms  of  drunkards,  relieving  the  nausea,  tremors, 
vertigo,  insomnia,  tinnitus  and  hallucinations.  Taken  during  the 
evening  it  prevents  night-sweats.  Felter  and  Lloyd  give  the  follow- 
ing specific  indications:  Nervous  dyspepsia,  broad  tongue  and  full 
abdomen,  gastric  ulcer,  chronic  gastritis  with  free  mucous  secre- 
tion ;  night-sweats. 

The  book  doses  of  zinc  oxide  are  too  large.  It  is  best  given  in 
doses  of  gr.  1-6  to  I  every  hour  or  two,  stopping  when  there  is  the 
first  sign  of  irritation.  It  is  the  least  irritant,  most  effective  and 
safest  preparation  of  zinc  for  the  effects  of  that  metal. 

ZINC   PHOSPHIDE. 

Standard  granules— Gr.  1-67,  gm.  .001 ;  gr.  1-6,  gm.  .01. 

The  action  of  zinc  phosphide  being  identical  with  that  of  phos- 
phorus, we  will  consider  here  the  latter  element,  looking  upon  the 
salt  named  as  the  best  available  means  of  securing  the  therapeutic 
effects  of  phosphorus. 

Physiologic  and  Toxic  Actions. — Large  doses  of  phosphorus  have 
been  swallowed  without  harm  resulting,  because  its  insolubility  pre- 


372  ZINC    PHOSPHIDE 

vents  its  absorption.  But  if  absorbed  it  causes  toxic  symptoms  in 
very  small  doses.  Two  grains  have  proved  fatal  to  man.  Phos- 
phorus vapor  is,  absorbed  by  the  lungs  and  causes  poisoning  in  fac- 
tories. It  is  absorbed  and  exerts  its  effects  as  phosphorus  itself. 

No  effect  is  manifested  from  toxic  doses  for  some  hours ;  when 
pain  and  uneasiness  is  felt  in  the  stomach,  nausea,  eructations  of 
garlicky  odor,  and  vomiting  of  matters  with  the  same  odor ;  which 
are  phosphorescent.  There  may  be  vomiting  of  bile,  and  diarrhea. 
These  symptoms  may  last  some  days  or  cease  after  the  stomach  has 
been  washed  out.  But  they  are  apt  to  recur,  with  jaundice,  pain  ex- 
tending to  the  liver,  and  over  the  abdomen.  The  vomitus  may  be 
bloody.  There  is  pronounced  debility,  pulse  weak,  liver  enlarged, 
urine  albuminous,  ecchymoses  and  hemorrhages  from  the  mucosa, 
collapse  and  coma.  Convulsions  and  delirium  may  precede  death. 
Death  may  occur  at  any  stage.  Recovery  may  occur  even  from  the 
second  stage. 

Exposure  to  the  fumes  of  phosphorus  causes  necrosis  of  the 
lower  jaw.  It  is  apt  to  start  with  a  carious  tooth.  It  may  also 
cause  chronic  poisoning,  with  cachexia,  jaundice,  anemia  and 
albuminuria;  followed  by  chronic  enteritis,  diarrhea,  bronchitis,  and 
fragility  of  the  bones. 

Fat  globules  appear  in  the  cells  of  the  liver,  kidney,  glands  of 
the  stomach  and  bowels,  and  the  muscular  fibers  of  the  heart, 
stomach,  intestine,  small  arteries  and  sometimes  in  the  striated 
muscles.  Cirrhosis  appears  in  the  stomach,  liver  and  kidneys. 

When  doses  too  small  to  set  up  the  above  symptoms  are  taken, 
changes  occur  in  the  growing  bones.  Dense  bone  is  deposited  in 
cartilage  instead  of  cancellous,  and  formed  calcellous  bone  is  ab- 
sorbed. The  medullary  cavity  is  thus  enlarged. 

When  death  occurs  early  in  poisoning  from  phosphorus  it  is  due 
to  a  direct  action  upon  the  cardiac  muscle.  The  blood  does  not 
clot  as  readily  as  usual.  Small  doses  increase  the  red  cells,  but  not 
the  hemoglobin,  and  lessen  the  number  of  white  cells.  Fatty  de- 
generation of  the  epithelium  explains  the  gastrointestinal  symptoms. 
The  enlargement  of  the  liver  is  due  to  fat.  The  renal  epithelium 
becomes  fatty,  and  fatty  casts  and  globules  appear  in  the  urine,  with 
blood  and  hemoglobin.  At  first  the  excretion  of  urine  is  increased, 
later  it  becomes  scanty  and  may  cease.  The  excretion  of  nitrogen 
is  lessened  by  the  vomiting  but  later  increases,  even  if  fasting.  Am- 
monia increases  much  more  than  urea.  Sarcolactic  acid  is  found 
in  large  amount;  the  uric  acid  is  little  altered,  the  extractives  in- 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


ZINC    PHOSPHIDE  373 

creased;  tyrosin,  leucin,  albumin  and  peptone  appear.  Harnack 
found  some  substances  not  peptones  though  closely  related.  The 
chlorides  are  much  reduced,  the  phosphates  increased,  as  are  the  sul- 
phates, and  bile  may  be  present.  All  these  alterations  point  to  a 
grave  derangement  of  metabolism.  The  alkalinity  of  the  blood  is 
reduced.  The  glycogen  of  the  liver  is  remarkably  reduced.  The 
two  factors  conclusively  shown  to  exist  in  phosphorus  poisoning  are 
fatty  degeneration  and  lessened  oxidation  in  the  tissues. 

Phosphorus  has  little  effect  on  microorganisms,  or  on  the  diges- 
tive ferments.  Phosphorus  is  partly  oxidized  in  the  body,  partly 
excreted  by  the  lungs,  and  partly  by  the  kidneys  in  various  combina- 
tions. 

Phosphorus  poisoning  calls  first  for  thorough  evacuation  of  the 
stomach,  as  the  poison  is  absorbed  slowly.  Oil  of  turpentine  forms 
with  phosphorus  compounds  not  very  toxic,  and  may  aid  in  its  oxida- 
tion ;  hence  is  used  as  an  antidote.  The  benefits  are  doubtful.  Sul- 
phate of  copper  is  also  used  as  an  emetic  and  as  forming  an  in- 
soluble compound.  In  the  secondary  stage  alkalies  are  given  to 
neutralize  the  excess  of  acid.  The  necrosis  is  treated  surgically. 

Therapeutics. — Phosphorus  has  proved  useful  in  rickets  and  in 
osteomalacia,  This  has  led  to  its  use  for  caries  and  necrosis,  and 
for  ununited  fractures.  Phosphorus  has  been  largely  employed  as  a 
remedy  for  nervous  debility  and  exhaustion,  neurasthenia,  insomnia, 
the  results  of  over  mental  work;  also  for  the  more  serious  conse- 
quences of  such  excesses,  softening  of  the  brain,  or  paresis,  with 
very  little  demonstrable  benefit.  As  a  general  tonic  its  use  betrays 
ignorance  or  culpable  rashness  on  the  part  of  the  prescriber.  It  is 
too  dangerous  a  drug  to  be  employed  as  a  substitute  for  iron, 
quinine  and  the  hypophosphites.  In  many  neurotic  maladies  it  is 
given  with  the  hope  rather  than  the  expectation  of  benefit ;  such  as 
all  forms  of  paralysis,  locomotor  ataxia,  and  the  whole  line  of  con- 
vulsive affections. 

In  neuralgia  its  use  is  better  based:  In  dealing  with  pure 
neuroses  there  is  something  in  taking  the  malady  by  storm,  as  it 
were;  and  a  course  of  treatment  instituted  vigorously  at  the  begin- 
ning will  succeed  in  making  a  favorable  impression  when  the  same 
remedies  given  timidly  till  the  system  has  become  accustomed  to 
them  will  fail.  To  such  a  case  as  an  inveterate  neuralgia  give  zinc 
phosphide  gr.  1-6,  and  the  arsenate  of  strychnine  gr.  1-50,  the  arse- 
nates  of  iron  and  quinine  gr.  1-6  each,  with  atropine  valerianate  gr. 
1-134;  all  together  every  four  hours,  and  within  two  days  the  force 


374  ZINC    PHOSPHIDE 

of  the  malady  will  be  broken,  and  milder  doses  will  complete  the 
cure.  When  any  neurosis  is  traceable  to  sexual,  alcoholic  or  other 
excesses,  phosphorus  may  prove  beneficial.  Senile  degenerations 
may  be  temporarily  benefited  by  this  potent  agent,  but  in  impotence 
the  writer  has  never  seen  any  but  ill  results.  There  may  be  a 
momentary  stimulation  of  the  sexual  function  but  it  is  followed  by 
quicker  exhaustion.  Phosphorus  will  not  make  an  old  man  young; 
but  that  is  exactly  what  we  are  asked  to  do  with  it. 

It  has  been  advised  in  melancholy,  dementia,  various  forms  of 
mental  failure  and  aberrations,  but  not  even  occasional  success  has 
resulted  from  the  writer's  use  of  the  drug  here.  Scudder  advised  it 
through  the  whole  line  of  chronic  and  atonic  vesical  and  seminal 
affections,  but  its  value  has  not  been  demonstrated. 

In  the  low  stages  of  fevers,  typhoid,  pneumonia  and  malaria, 
phosphorus  has  been  recommended  as  a  stimulant;  but  just  now 
strychnine  is  preferred.  Still  there  may  be  a  place  here  for  phos- 
phorus. The  use  of  modern  methods  in  these  and  other  fevers  has 
rendered  such  emergencies  almost  obsolete. 

The  use  of  phosphorus  for  fatty  degeneration  of  the  liver,  and 
for  malignant  jaundice  is  no  more  to  be  condemned  as  "homeo- 
pathic" than  its  undoubted  use  in  rickets  and  osteomalacia. 

Felter  and  Lloyd  give  as  specific  indications :  Nervous  exhaus- 
tion, atony,  vesical  and  prostatic  irritation  with  mucoid  discharges ; 
fullness  and  dragging  in  the  perineum ;  weariness  in  legs ;  mucoid 
rectal  discharges ;  low  muttering  delirium  in  low  fevers  with  in- 
voluntary discharges;  chronic  bronchial  and  pulmonary  affections 
with  heat,  dryness,  hacking  cough,  and  difficult  expectoration  of 
mucopurulent  or  sanguineous  sputa;  rusty  sputa;  pulmonary  hy- 
peremia;  pinkish  face  with  staring  eyes;  expressionless  pasty 
tongue ;  insufficiency  of  the  internal  recti  of  the  eye ;  sexual  debility. 

The  writer  has  employed  zinc  phosphide  for  many  years  in  every 
case  of  herpes  zoster  applying  for  treatment,  and  has  never  found 
a  case  that  resisted  the  remedy.  He  gives  gr.  1-6  an  hour  before 
each  meal  to  an  adult,  and  within  two  days  the  attack  is  under  con- 
trol. As  this  malady  is  due  to  degeneration  of  the  roots  of  the  af- 
fected nerves,  there  is  reason  for  the  use  of  the  same  remedy  in 
other  maladies  dependent  on  that  condition ;  and  in  this  also  we  have 
not  been  disappointed.  Localized  neuroses  in  general  come  under 
this  description  and  for  them  we  would  urge  a  trial  of  this  remedy. 

The  full  adult  dose  of  zinc  phosphide  we  would  place  at  gr.  1-6 
four  times  a  day,  given  as  far  as  possible  from  the  meals  to  avoid 


ZINC    SULPHOCARBOLATE  375 

the  development  of  phosphureted  hydrogen.  The  difficulties  en- 
countered in  administering  phosphorus  are  so  numerous  that  it 
seems  advisable  to  go  over  the  whole  list  for  which  it  has  been  ad- 
vised with  the  more  manageable  and  safer,  yet  efficient,  zinc  phos- 
phide. 

ZINC  SULPHOCARBOLATE. 

Standard  granules  and  tablets — Gr.  1-6,  gm.  .01;  gr.  i,  gm.  .06;  gr.  2, 
gm.  .15;  gr.  5,  gm.  .3. 

The  sulphocarbolates  were  introduced  many  years  ago,'  as  intes- 
tinal disinfectants,  but  fell  into  disuse  before  they  were  fairly  tried. 
Two  arguments  were  adduced  against  them — that  it  was  impossible 
to  render  the  alimentary  canal  free  from  germs;  and  that  these 
agents  being  soluble  they  were  absorbed  from  the  stomach  and  did 
not  get  down  to  the  intestine  where  their  effects  were  most  desired. 

In  regard  to  the  first  objection,  it  is  well  to  ask  whether  it  is 
really  necessary  to  destroy  every  living  inhabitant  of  the  alimentary 
canal  in  order  to  do  any  good  ?  There  are  many  ways  by  which  the 
great  benefits  derived  from  the  intestinal  antiseptics  may  be  ex- 
plained. They  may  destroy  a  portion  of  the  microorganisms;  or 
prevent  their  multiplication;  or  neutralize  the  toxins  produced  by 
them ;  or  prevent  their  inroads  upon  the  mucous  tissues ;  or  render 
the  tissues  more  resistant;  or  interfere  with  the  attacks  of  the 
ordinary  putrefactive  bacteria  that  follow  in  the  wake  of  specific 
organisms  like  the  typhoid  bacilli  and  break  down  the  weakened 
structures.  In  fact,  we  do  not  know  so  much  of  the  life  history  and 
the  operations  of  the  various  bacteria  that  we  can  predicate  on  the 
usefulness  of  such  an  agent  simply  because  it  does  not  do  some  one 
thing  that  we  have  set  up  arbitrarily  as  a  test  of  its  value.  The  only 
test  worth  serious  consideration  is  that  of  clinical  trial ;  and  the 
question  is  not  whether  the  remedy  does  this  or  that,  but  how  we 
can  best  explain  the  phenomena  which  follow  its  administration. 
This  question  has  been  wholly  ignored  by  the  opponents  of  the 
practice  of  intestinal  antisepsis. 

An  insoluble  agent  is  inert  until  it  is  in  solution.  Then  it  is  no 
longer  insoluble.  Many  attempts  have  been  made  to  devise  means 
of  getting  remedies  past  the  stomach  to  be  dissolved  only  when  they 
reach  the  small  bowel,  but  the  solvent  powers  of  the  gastric  juice 
are  exerted  even  over  keratin.  This  is  an  a  priori  consideration — 
we  have  as  yet  seen  no  attempt  at  demonstration  of  the  assertion  that 
agents  soluble  in  the  stomach  will  not  disinfect  the  intestine.  We 


376  ZINC    SULPHOCARBOLATE 

are  therefore  again  reduced  to  the  necessity  of  relying  on  the 
phenomena  observed  clinically,  and  here  we  find  that  the  administra- 
tion of  the  sulphocarbolates  in  efficient  doses  is  "invariably  followed 
by  a  cessation  of  the  fetid  odor  of  the  stools.  Why  this  should  be, 
if  the  soluble  antiseptics  have  no  action  in  the  intestine,  we  leave 
those  who  believe  that  dogma  to  explain. 

The  writer  has  possibly  administered  more  of  the  sulphocar- 
bolate  of  zinc  than  any  other  man  living;  and  he  has  not  observed 
any  effects  from  it  except  those  exerted  in  the  alimentary  canal. 
If  impure,  or  given  in  too  large  doses  or  too  concentrated  form,  it 
irritates  the  stomach  and  may  even  cause  vomiting.  But  the  chem- 
ically pure  salt  has  been  given  many  times  in  doses  of  ten  grains 
each,  and  up  to  two  drams  in  24  hours,  without  any  such  effects. 
There  are  conditions  of  the  stomach  when  many  agents  not 
ordinarily  irritant  will  provoke  nausea  or  cause  soreness.  Some- 
times a  granule  of  veratrine  in  half  a  glass  of  water  will  give  rise  to 
a  sense  of  warmth  or  tenderness  that  will  outline  the  stomach  ac- 
curately. A  five-grain  tablet  of  potassium  bromide  swallowed 
whole  caused  a  brother  physician  to  roll  on  the  floor  in  agony ;  and 
yet  this  is  not  considered  specially  irritant.  It  is  wise  to  give  the 
sulphocarbolates  in  solution  or  trituration  with  abundance  of  diluent. 

Therapeutics. — Typhoid  Fever.  In  all  cases  it  is  best  to  first 
completely  empty  the  bowels.  It  is  useless  to  try  to  disinfect  the 
intestine  if  there  is  the  mechanical  obstacle  of  masses  of  feces  into 
which  the  disinfectant  cannot  penetrate.  Give  a  dose  or  two  of 
calomel  and  then  a  saline  laxative ;  and  when  the  bowels  have  been 
cleared  out  well  begin  with  the  zinc  sulphocarbolate,  giving  from 
2^-2  to  5  grains  every  two  hours  until  the  stools  are  devoid  of  all 
unpleasant  odor.  After  this  half  the  above  doses,  or  even  less,  will 
suffice  to  keep  the  stools  deodorized,  and  this  will  disinfect  them  suf- 
ficiently to  secure  all  the  advantages  of  the  method.  The  gastric 
and  intestinal  symptoms  subside  as  the  stools  become  odorless ;  the 
fever  drops  a  degree  or  more,  the  aching,  delirium  and  other 
nervous  phenomena  are  alleviated,  and  the  whole  aspect  of  the  case 
has  changed  for  the  better.  If  employed  early  enough  many  cases 
are  shortened  or  aborted,  so  that  the  physician  who  begins  to  employ 
this  method  soon  has  trouble  with  his  diagnoses. 

Cholera  Infantum.  In  all  cases  when  the  child's  stools  begin  to 
be  offensive  treatment  analogous  to  that  of  typhoid  fever  should 
be  instituted.  Give  calomel  in  very  small  doses,  or  rhubarb,  and 
empty  the  alimentary  canal ;  then  begin  with  zinc  sulphocar- 


ZINC    SULPHOCARBOLATE  377 

bolate,  gr.  1-6  to  2  every  hour  according  to  the  gravity  of 
the  case,  and  continue  until  the  stools  are  disinfected.  If  choleraic 
symptoms  are  present  begin  at  once  with  the  zinc.  It  is  best  given 
with  bismuth,  saccharated  and  pepsin  if  there  is  nausea  or  vomiting 
— enough  of  each  to  well  dilute  the  zinc.  Half  a  grain  of  the  latter 
with  two  to  five  grains  of  each  of  the  other  agents  is  a  fair  average 
formula. 

Fevers:  In  all  fevers,  essential  and  symptomatic,  the  above 
method  of  emptying  and  disinfecting  the  bowels,  will  result  in  an 
amelioration  of  the  symptoms  amounting  to  thirty  or  forty  per  cent. 
There  is  no  febrile  disease  in  which  a  large  part  of  the  symptoms, 
the  discomfort  and  danger,  are  not  due  to  absorption  of  toxic  mat- 
ters from  the  alimentary  canal — at  least  we  are  sure  our  readers  will 
admit  that  such  absorption  cannot  be  of  any  advantage  to  the  pa- 
tient. This  seems  to  have  been  better  comprehended  by  the  physi- 
cians of  half  a  century  ago  than  it  is  today ;  excepting  in  the  malarial 
sections,  where  the  necessity  of  having  the  bowels  clear  and  clean 
is  generally  admitted  and  acted  upon. 

Phthisis:  It  was  a  lesson  the  writer  has  never  forgotten,  when 
he  first  applied  to  a  consumptive  the  principle  of  clearing  out  the 
bowel  and  disinfecting  it.  The  same  fall  in  the  fever  occurred  as  in 
typhoid  fever,  the  other  symptoms  were  ameliorated,  and  the  ap- 
petite, hitherto  wanting,  became  voracious.  This  one  measure 
produced  in  the  patient  more  improvement  than  the  most  ingeniously 
devised  treatment  had  previously  accomplished. 

In  fermentive  dyspepsias,  and  all  cases  where  the  stools  are 
malodorous,  this  agent  will  prove  promptly  effective.  It  is  an  ad- 
mirable remedy  for  children,  who  very  frequently  need  something 
of  the  sort.  While  clearing  out  the  bowels  will  do  good,  it  needs 
but  a  trial  to  convince  anyone  of  the  greater  benefit  coming  from  the 
disinfection.  The  alkaline  syrup  of  rhubarb  makes  an  excellent 
excipient  for  the  sulphocarbolates. 

When  there  is  acidity,  or  when  the  zinc  proves  irritating  even  if 
given  properly  extended,  the  stilphocarbolate  of  soda  is  useful.  It 
is  not  as  antiseptic  as  the  zinc,  and  should  be  given  in  double  the 
doses  recommended  for  the  latter. 

In  dealing  with  scrofulous  children,  in  the  peculiar  diarrhea  of 
rickets,  and  for  consumptives  who  are  having  night-sweats,  the 
sulphocarbolate  of  lime  may  be  used.  It  is  about  the  same  strength 
as  the  soda  salt.  In  fact,  whenever  the  reconstructive  effects  of 


378  ZINC   VALERIANTE 

lime  are  indicated,  this  is  the  sulphocarbolate  of  choice.     It  may  be 
given  with  the  hypophosphite  or  other  salts  of  lime. 

ZINC  VALERIANATE. 

Standard  granule — Gr.  1-6,  gm.  .01. 

Zinc  valerianate  presents  one  of  the  best  agents  from  which  to 
secure  the  remedial  values  of  valerian.  The  dose  is  small,  the  acid 
active,  and  through  the  whole  line  of  its  action  the  zinc  favors  the 
effects  of  the  valerian. 

Felter  and  Lloyd  mention  this  agent  as  an  antispasmodic,  used 
in  neuralgias,  especially  spinal  and  of  the  fifth  nerve ;  also  in  chorea, 
epilepsy,  neuralgic  and  nervous  headaches,  hysteria,  sciatica, 
ovaralgia,  and  angina  pectoris.  The  specific  indications  are:  Colic, 
reflex  from  ovarian  or  uterine  disease,  headache,  paleness,  dizziness, 
sleeplessness,  anemia. 

Many  cases  of  insomnia  are  over-treated.  Due  to  nervousness, 
they  are  quickly  relieved  by  a  few  granules  of  zinc  valerianate. 
Nervous  unrest,  worry,  irritability,  crossness,  fidgets,  even  well- 
founded  grief  such  as  that  from  the  death  of  a  friend,  are  relieved 
by  valerian.  Or  at  least  it  enables  the  afflicted  one  to  bear  the  grief 
with  equanimity,  to  hold  the  emotions  under  decorous  control. 
Probably  all  forms  of  disturbed  nervous  and  emotional  equilibrium 
are  tranquilized  by  this  remedy. 

The  writer  has  found  the  insomnia  of  typhoid  fever  yield  to  zinc 
valerianate  in  very  moderate  doses.  Even  that  occurring  during  the 
withdrawal  of  morphine  from  a  habitue  is  notably  benefited  by 
valerian.  Sexual  excitement  is  regulated  by  this  agent,  controlled 
but  not  weakened,  and  for  nymphomania,  satyriasis,  spermatorrhea, 
and  the  erethism  so  common  after  abuse  of  the  sexual  functions 
there  is  no  better  agent  for  restoring  the  strength  and  the  control  at 
the  same  time.  This  remedy  is  as  useful  for  one  sex  as  for  the 
other.  If  the  patient  has  been  in  the  habit  of  taking  the  powerful 
stimulants  or  hypnotics  much  larger  doses  of  the  valerian  prepara- 
tions are  necessary. 

The  dose  of  zinc  valerianate  for  an  adult  is  gr.  1-6  to  1-2  re- 
peated every  quarter-hour  till  effect.  Overdoses  simply  irritate 
through  the  zinc. 


THERAPEUTIC    NOTES 


THERAPEUTIC    NOTES 


INDEX 


ABBOTT'S  paste.  48 
Abortifacients,  gossypin,  235 
Abortion,  cornutine,  180 

habitual,  eupatorium,  225 

to  prevent,  caulophyllin,  135 

threatened,  collinsonin,  168 
hydrastinine,  246 
viburnin,  364 
Abrus,  134 
Abscess,  echinacea,  210 

dermal,  phytolacca,  302 
Acidity,  gastric,  atropine,  68 
Acne,  ergot,   182 

hydrastine,  243 

stypticin,  289 
Aconitine,  I 

physiologic  and  toxic  actions,  2 

toxicology,  4 

therapeutics,  6 
Addison's  disease,  iris,  255 
Adenitis,   atropine,  68 
After-pains,   atropine,   68 

caulophyllin,   135 

gelsemium,  227 

viburnin,  364 

xanthoxylin,   366 
Aged,  nuclein,  297 
Agnus  castus,  verbena,  362 
Alant-camphor,  238 
Albuminuria,  bloody,  senecin,  343 

calcium  benzoate,  84 

cocaine,  159 

eupatorium,  224 

lycopus,  271 

of  pregnancy,  pilocarpine,  310 
Alcohol  habit,  croton  oil,   187 
gelsemium,  227 
strychnine,  351 

Alcoholism,  acute,  capsicum,  132 
atropine,  68 

cocaine  with  capsicin,   158 
emetine,  216 
strychnine,  350 

chronic,    zinc  oxide,  371 
collinsonia,  170 
quassin,   319 
Alopecia,  cantharides,    126 

pilocarpine,  310 

circumscripta,  veratrine,  361 
Alteratives,  phytolacca,  302 
Amanita  muscaria,  63,  284 


Amaurosis,  pilocarpine,  ->io 

strychnine,  352 
Amblyopia,   pilocarpine,   310 
Amenorrhea,  arsenic,  47 
anemic,  iron  arsenate,  317 
potassium   permanganate,   316 
sanguinarine,  337 
caulophyllin,   135 
collinsonin,  168 
eupatorium,  225 
senecin,  343 
iron,  259 
podophyllin,  313 
gossypin,  235 
gold,  234 
verbena,  362 
Ammonium  benzoate,  83 

picrate,  304 

Anemia,  condurangin,  174 
iron,  258 
lecithin,  267 
nuclein,  293 
pernicious,  arsenic,  46 
cetrarin,  139 
picric  acid,  304 

Anesthesia,  local,  brucine,  93,  160 
cicutine,   148 
cocaine,  157 
Anesthetic,    hyoscine    and    morphine, 

249 

local,  strophanthin,  346 
Aneurism,  veratrine,  361 
Angina  pectoris,  arsenic,  46 
capsicum,  133 
convallamarin,    177 
cicutine,    148 
glonoin.   230 
lobelia,  270 
phytolacca,  303 
zinc  valerianate,  378 
Angina  of  scarlet   fever,  phytolacca. 

303 

Anorexia,  arsenic,  46 

helenin,  240 

verbena,  362 

Antaphrodisiac,  cicutine,  148 
Antipyretic,  aspidospermine,  56 

quinine,  325 
Antiseptol,  151 

Aortic  insufficiency,  digitalin  contra- 
indicated,  202 


380 


INDEX. 


Aortic,  stenosis,  digitalis,  contraindi- 

cated,  202 
Aphonia,  atropine,  68 

collinsonin,   169 
Aphrodisiac,  asparagin,  52 

yohimbine,  367 
Aphthae,  geranin,  229 

febrile,    veratrine,   359 

iridin,  255 

phytolacca,  302 
Apoplexy,  croton  oil,   187 

infantile,  lobelia,  270 
Aporhetin,   327 
Appendicitis,   boldine,  91 

catarrhal,  atropine,  65 

codeine,  162 

hyoscyamine,  251 
Aquila  alba,  236 
Arbutin,  142 
Arrow  poison,   188 
Arsenic,  administration,  48 

dosage,  48 

salts  of,  49 
Arsenical    pastes,    48 
Arsenites,  50 
Artemisia  maritima,  138 
Arteriosclerosis,  gold,  234 

strophanthus,  347 
Arthritis,  nuclein,  293 

chronic,  veratrine,  361 
Ascites,  colchicine,   167 
Asclepias   tuberosa,   50 

specific  indications,  51 
Asclepidin,  50 
Ash,  prickly,  365 
Asparagin,  52 
Aspen,  American,  315 
Aspergillus   eurotium   oryzae,    191 
Asphyxia,  glonoin,  233 
Aspidosanine,   53,  54 
Asperdospermine,  administration  and 

dosage,  56 

Aspidospermatine,  53,   54 
Asthenopia,  muscular, gelsemium,  227 
Asthma,  arsenic,  46 

benzoin,  81 

bronchial,  347 

caffeine,  105 

calcalith,   in 

calcium  iodized,  ii=? 

camphor  monobromide,   118 

cannabis,  122 

cardiac,  jalap,  262 
strychnine,  351 

cicutine,   147,  149 

cocaine,  159 

collinsonin,    169 

convallamarin,    177 

cubebin,  188 

dioscorea,  208 


Asthma,  eupatorium,  225 

glonoin,  230 

hyoscyamine.  251 

humid,   sanguinarine,  338 

lobelia,  270 

macrotin,  273 

nuckin,  293 

pilocarpine,   310 

spasmodic,  helenin,  240 
emetine,  216 
quinine,  326 
Ataxia,  santonin,  340 
Atheroma,    digitalin    contraindicated, 

202 
Atony,  gastrointestinal,  berberine,  86, 

.87 
Atropine,  57 

administration,  67 
as  cycloplegiac,  59,  63 
synergists  and  antagonists,  62,  65 
theraneutic   summary,   68 
toxic  dose,  68 
Avenine,  72 

BACKACHE,  macrotin,  273 

xanthoxylin,  366 
Baptin,  74 
Baptisin,  73 
Baptitoxine,  73 
Barium  chloride,  75 
Barosmin,   78 
Basham's  mixture,  259 
Bebeerine,  78 
Belladonna,  57 
Benzoic  acid,  79 

dosage  and  administration,  84 
Berberine,  85,  274 

dosage,  87 

and  hydrastinine,  246 
Bhang,  120 
Bile  excretion,  increased  by  boldine, 

89,  91 

Bilious  colic,  dioscorein,  208 
Biliousness,  chionanthin,  143 

iridin,  255 

podophvllin,  313 
Bites,  insect,  echinacea,  210 
ipecac,   218 

snake,    echinacea,   210 

and  insect,  pilocarpine,  310 

strychnine,  350 
Blackhaw,  363 
Bladder,   irritable,    atropine,   68 

cantharides,  127 
Blepharitis,    hydrastine,    243 
Blepharospasm,  cicutine,  147 

codeine,  161 

Blood,  "bad,"  iridin,  255 
rumicin,  333 

poisoning,  salicylic  acid,  336 


INDEX. 


381 


Blue  flag,  254 
Boils,  atrooine,  68 
echinacea,  210 
hydrastine,  243 
phytolacca,  302 
rhus  tox,  331 
veratrine,  359 
Boldine,  88 
dosage,   90 
therapeutics,  89 
Boldo-glucin,  90 
Boxwood,  78 

Brain,  congestion  of,  croton  oil,  187 
Brayera  anthelmintica,  264 
Breasts,  tenderness  of,  phytolacca, 303 
Bromo-caffeine,   107 
Bromidrosis,  hydrastin,  242 
Bronchitis,  atropine,  68 
camphor  monobromide,  118 
capillary,  ipecac,  218 

sanguinarine,  3^8 
caulophyllin,  136 
cetrarin,   139 

chronic,  ammonium  benzoate,  83 
benzoin,  81 
calcium  iodized,  115 
collinsonin,   169 
euonymin,  223 
helenin,  239 
ipecac,  218 
sodium  benzoate,  84 
zinc  phosphide,  374 
creasote,   186 
cubebin,  188 
lobelia,  270 
nuclein,  293 
pilocarpine,   309 
sanguinarine,  338 
spasmodic,  cicutine,  147 
Bronchopneumonia,   helenin,  239 
emetine  and  brucine,  294 
ootassium  bichromate  294 
nuclein,  293 
quinine,  326 
Bronchorrhea,  atropine,  65 

creasote,  186 
Brucine,  91,  347 
dosage,  93 

an  emergency  remedy,  92 
Brunton's  paste,  48 
Bryonia  dioica,  94 
Bryonin,  94 

specific  indications,  94,  95 
Buchu,  78 
Bugle  weed,  271 
Bulimia,  codeine,  161 
Burns,  picric  acid,  304 
Butternut,  262 

Butyl  chloral  hydrate,  dosage,  97 
antidote,  97 


CACTIN,  98 
Cachexia,  iridin,  255 

iron,  258 
Caffeine,  99 

dosage,  101,  106 

synergists,  103 
Calabar  bean,  300 
Calaborine,  300,  347 
Calcalith,  108 
Calcidin,  112 
Calcium  benzoate,  84 

carbonate,  108 
elimination  of,  no 

iodized,  112 
Calculi,  biliary.  68 
podoohyllin,  314 

renal,  68 
eupurpurin,  224 

urinary.  83 

vesical,  verbena,  362 
Camphor  monobromide,  117 
Cancer,  arsenic,  47 

cantharidin,  129 

chelidonin,   140 

cicutine,  147,  149 

codeine,  162 

condurangin,  174 

and  nuclein,  294 

echinacea,  211 

gossypin,  235 

hydrastin,  conium  and   phytolacca, 
224 

nuclein.  294 

salicylic  acid,  336 
Cancroids,  chelidonin,   141 
Cannabin,  120 
Cannabindon,   120 
Cannabinine,   120 
Cannabis  indica,  120 
Cantharides,  123 
Cantharidin,  123 

aphrodisiac  action,  128 

dosage,   129 

Capillary  atony,  capsicum,  134 
Capsicin,   129 

therapeutics,   131 
Capsicum  as  gargle,  134 
Capticin.  288 
Carbuncles,  hvdrastine,  243 

echinacea,  210 

phytolacca,  302 

rhus  tox,  331 

veratrine,  359 

Cardiac  irritability,  lycopus,  271 
Cardialgia,  atropine,  64 

podophyllin,  313 
zinc  cyanide,  370 
Carica  papaya,  298 
Castus  indicus,  362 
Catalepsy,  zinc  oxide,  371 


382 


INDEX. 


Cataract,  immature,  atropine,  68 
Catarrhs,  acute,  atropine,  66 

calcium  iodized,   115 

chronic,  lobelia,  270 

collinsonin,  169 

duodenal,  hydrastin,  242 

gastric,   emetine,  216 
hydrastin,  242 

gastrointestinal,  berj>erine,  86 

gouty,  colchicine,    167 

nasal,  sanguinarine,  338 

nasopharyngeal,  hydrastine,  243 

pharyngeal,  capsicum,  131 

respiratory,  sanguinarine,  338 

sodium  benzoate,  84 

vesical,  cubebin,  188 

chimaphilin,  142 
Cathartics,  colocynthin,  171 

podophyllin,  312 
Caulophyllin,  134 

dosage.  136 

specific  indications,  136 
Celandine,  139 

Cellulitis,  pelvic,  hydrastine,  243 
Cephaeline,  137,  218 
Cerebral  anemia,  atropine,  68 
gold,  234 

congestion,   atropine,   68 
colchicine,   168 

inflammations,  atropine,  67 
Cerebrospinal    meningitis,    echinacea, 

2IO 

gelsemium,   227 
hyoscine,  248 
Cerium  nitrate,  138 

oxalate.  137 

Cervix,  lacerated,  hydrastine,  243 
Cetrarin,  138 
Cevadilline,  354 
Cevadine,   354 
Chafing,  hamamelis,  237 
Chancroid,  hydrastin,  242 

iodoform,  253 
Chaps,  benzoic  acid,  83 
Chelidonin,   139 

dosage,  141 

Chelidonium  ma  jus,  337 
Chelidoxanthine,  139 
Chills,  capsicum,   133 

congestion,  piperine,  312 

nervous,  strophanthus,  347 

malarial,  glonoin,  232 
pilocarpine,  310 
quinine,  324 

urethral,  strophanthus,  347 
Chilblains,  capsicum,   134 
Chionanthin,  143 
Chionanthus  virginica,  143 
Chimaphilin,    142 
Chloroanemia,  helenin,  240 


Chlorosis,  lecithin,  267 

senecin,  343 
Cholagogs,  iridin,  255 
mercury,  278 
quassin,    319 
Cholecystitis,   chionanthin.    143 

boldine,  88,  89 
Cholera,  Asiatic,  atropine  in,  66,  68 

camphor  monobromide,  118 

capsicum,  133 

ipecac,  218 

piperine,  312 

potassium  permanganate,  317 

xanthoxylin,  365 
infantum,  66,  69 

capsicum,   133 

copper  arsenite,  178 

echinacea,  210 

emetine,  216 

nuclein,  294 

podophyllin,  .313 

resorcin,  327 

sulphocarbolates,   376 

xanthoxylin,  365 

zinc  sulphocarbolates,  376 
morbus,  66,  68 

capsicum,    133 

cocaine,  1=59 

dioscorea,  208 

echinacea,  210 

emetine,    216 

xanthoxylin,  365 
Chordee,  atropine,  169 
camphor  monobromide,  118 
cannabis,  122 
cantharides,    126 
colchicine,  167 
gelsemium,  227 
Chorea,  arsenic,  46 
atropine,  66,  69 

camphor  monobromide,  118,  119 
cerium    oxalate,    138 
cicutine,   147 
cocaine,   159 
curarine,  189 
cypripedin,    190 
ergotin,  222 
gelsemium,  227 
hyoscyamine,  250 
lobelia,  269 
macrotin,  273 
nuclein,  294 
picrotoxin,  306 
scutellarin,   342 
strychnine,  352 
veratrine,  359 
viburnin,  364 
zinc  cyanide,  369,  370 
zinc  oxide,  371 
zinc  valerianate,  378 


INDEX. 


383 


Chrysophan,  327 
Chrysophanic  acid,  .327 
Chelerythrine,  139,  337 
Cicutine,   143 

antidotes,  146 

hydrobromate,  148 

local  administration,  148 

physiologic  and  toxic  actions,  144 

synergists  and  antagonists,   146 

therapeutics,  146 
Cimicifuga  racemosa,  272 
Cimicifugin,  274 
Cinchona,  320 

Cirrhosis,  hepatic,  iodoform,  253 
Cissampelos,  78 
Coca,  151 
Cocaine,  151 

cantharidate,  129 
dosage,  159 

habit,  152,  155 

incompatibles,   157 

physiologic  and  toxic  actions,  152 

poisoning,  treatment  of,  158 

synergists,   157 

therapeutics,  157 
Cocculus  indicus,  305 
Codeine,  160 

see  Gregory's  salt,  236 

dosage,  162 
Coffee,  99 
Cohosh,  black,  272 

blue,  134 
Colchicine,  163 

dosage,    168 

physiologic  action,  164 

poisoning,  treatment,   168 

synergists,  165 

therapeutics,  166 
Colchicum,  autumnale,    163 
Cold  feet,  capsicum,  134 
Colds,  atropine,  66 

capsicum,  131 

gelsemium,  228 

pilocarpine,  309 

verbena,  362 
Colics,  atropine,  64 

bilious,  dioscorein,  208 
gelsemium,  228 

caulophyllin,   135 

dioscorea,  208 

flatulent,  podophyllin,  313 
collinsonin,  170 

gastric,  menthol,  276 

hepatic,  hyoscyamine,  251 
glonoin,  230 
morphine,  282 

hyoscyamine  and  glonoin,  251 
collinsonin,   170 
cannabis  indica,   122 
codeine,    161 


Colics,  infantile,  collinsonin,   170 

lobelia,  270 
ovarian,  codeine,  161 
piperine,  312 
picrotoxin,  306 
renal,   gelsemium,  227 
cannabis  indica,  122 
collinsonin,    170 
glonoin,  230 
rhubarb,  328 

uterine,  santonin,  340 
viburnin,  363 

xanthoxylin,  365 
Colitis,  mucous,  arsenic.  47 
Collinsonia  canadensis,  168 
Collinsonin.   168 

dosage,  170 

indications,   169 
Colocyrrthin,  170 
Color  blindness,  santonin,  340 
Columbo,  85.  86 
Comedo,  iris,  255 
Compound  cathartic  pill.  172 
Condurangin.   172 

dosage,  176 

in  cancer,  178 

therapeutics,  174 
Congestion,  gelsemium,  226 

cardiac,  lobelia.  270 
Conium,   143 
Conjunctivitis,  gelsemium,  227 

acute,  macrotin,  273 

croupous, potassium   bichromate,3i6 

granular,  hydrastinine,  246 

hydrastine,  243 

phytolacca,  303 

rhus  tox,  331 
Connective  tissue,  contracted  by  ber- 

berine,  87 
Constipation,   atropine,   65 

berberine,  86 

capsicum,  1^2 

emetine,  217 

euonymin,  223 

hydrastine,  243,  244 

iridin,  255 

jalapin,  262 

juglandin,   263 

lobelia,  270 

mercury,  278 

physostigmine,  301 

podophyllin,  312 

strychnine,  354 

xanthoxylin,    365 
Consumption,    pulmonary,    iodoform, 

253 

Contusions,  hamamelis,  237 
Cqnvallamarin,  176 

indications  for,  178 
Convulsions,   atropine,   69 


384 


INDEX. 


Convulsions,  cicutine,  147 

gelsemium,  227 

hyoscine,   248 

hysteric,  narceine,  286 

infantile,  cicutine,   147 
lobelia,  270 

periodic,  273 

worm,  bryonin,  94 
Coprostasis,   hyoscyamine,   250 
Copper  arsenite,   178 
Coqueros,  152 
Cornin,   179 
Cornus   florida,    179 
Cornutine,  180,  220 
Corydalin,    183 
Corydalis  formosa,  183 
Cotarnine  opiate,  288 
Cotoin,   184 
Cotton  root,  235 
Cough,  atropine,  69 

chronic,   eupatorium.   224 

codeine,    162 

convulsive,   cicutine,   147 
zinc  cyanide,  370 

Gregory's  salt,  236 

dry,   emetine.  216 

iodoform,  162 

lycopus,  272 

morphine,  283 

narceine,  286,  287 

phthisical,  collinsonin,  169 

pharyngeal,  phytolacca,  302 

potassium  bichromate,  315 

reflex,  calcium  iodized,  116 

remedies  for,  162 

rumicin,    333 

spasmodic,  hyoscyamine,  250 
camphor  monobromide,  118 
cannabis  indica,  122 

tickling,  rhus  tox,  331 
Counterirritation,  croton  oil,  187 
Cramp,  caulonhyllin,  135 

gastric,  hyoscyamine.  2=52 

leg,  viburnin,  364 

stomach,  caulophyllin,  136 
Creasote,  185 
Croton  chloral,  96 

oil,   186 

Crotonolic  acid,   186 
Croup,  atropine,  69 

antispasmodics,   113 

baptisin,  74 

calcium  iodized,   113 

collinsonia,  170 

potassium  bichromate,  316 

membranous,  sanguinarine,  338 

spasmodic,   lobelia,  270 
Croup  vs.  diphtheria,  114 
Cubebin,    187 
Culver's  root,  leptandrin,  268 


Curare,  188 

Curarine,  188,  347 

Cyanosis  neonatorum,  glonoin,  232 

Cycloplegiac,  atropine,  59 

Cypripedin,  190 

Cypripedium  pubescens,   190 

Cystitis,  asparagin,  52 

atropine,  69 

barosmin,    78 

benzoic  acid,  81 

cantharides,    126 

caulophyllin,  135 

chimaphilin,  142 

collinsonin,   169 
Cystitis,  hydrastine,  243 

pipsissewa,  142 

ammoniacal,  lithium  salicylate,  336 
Cytisine,  73,  74 
Cystisus  scoparius,  34"? 


DEAFNESS,   pilocarpine,  310 
Debility,   helenin,  239 
hydrastin,   244 
male,  sanguinarine    337 
nuclein,  294 
poplar,  315 
quinine,  326 
senile,  capsicum,   133 
verbena,  362 
Delirium,  atropine,  69 
cannabis    indica,    122 
cypripedin,   190 
digitalin,   205 

febrile,  zinc  phosphide,  374 
hyoscyamine,  250 
tremens,  atropine,  69 
camphor  monobromide,  118 
capsicum,  131 
digitalin,  206 
emetine,  216 
gelsemium,   227 
hyoscyamine,  250 
macrotin,  273 
scutellarin,  342 
Delusions,  hyoscyamine,  250 
Dementia,  atropine,  69 
cannabis,  123 
verbena,  362 
Dengue,  atropine,  69 
Dentition,  atropine,   69 

gelsemium,    227 

Dermatitis,  acute,  rhus  tox,  331 
venenata,  echinacea,  211 
ipecac,  218 
lobelia,  270 

Development,  under-,  lecithin,  267 
Diabetes  insipidus,  atrooine,  69 
codeine,    162 
ergot,    182 


INDEX. 


385 


Diabetes  insipidus,  eupatoritim,  224 

ergotin,  222 

hamamelis,  237 

pilocarpine,  310 
mellitus,    cantharides,    127 

cocaine,   159 

codeine,   162 

diastase,   192 

ergot,    182 

geranin,  229 

gold,  234 

iodoform,  253 

lecithin,  267 

lycopus,  271 

morphine,  28 

nuclein,  294 

pilocarpine,  310 

potassium  permanganate,  317 
Diaphoresis,  emetine,  217 
Diarrhea,  atropine,  6=; 
berberine,  86 
chronic,   138        • 

picric  acid,  304 

potassium    bichromate,    316 

strychnine,  351 
copper  arsenite,   178 
coto,   184 
echinacea,  210 
emetine,   216 
geranin,  229 
hamamelis,   237 
hydrastine,  244 
infantile,  rhus  tox,  230 
juglandin,  263 
leptandrin,  268 
lienteric,  quassin,  319 
lycopus,  271 
morphine,  283 
narceine,  286 
nuclein,  294 
piperine,  312 
passive,  capsicum,  132 
potassium  bichromate,  316 
rhubarb,  328 
rhus  tox.,  330 
salicin,  336 
sodium  benzoate,  84 
viburnin,  363 
watery,  rumicin,  33 
Diastase,  191 
Digitalein,  193 
Digitalin,  200 
Digitalis,  antagonists,   200 
cumulative   action,    198 
dosage,  205 

how  long  administered,  207 
indications,   203 
synergists,  200 
therapeutics,  203 
varieties  of.   108 


Digitalis  purpurea,  193 

Digitin,  193 

Digiton,  physiologic  action,  196 

Digitonin,  193 

Digitoxin,  193 

toxic  action,  198 
Diuretic,  digitalin  as,  205 
Diuresis,  to  produce,  calomel,  278 
Dioscorea  vittata,  208 
Dioscorein,  208 
Diphtheria,  294 

arsenic  a  prophylactic,  47 

atropine,  69 

echinacea,    210 

nuclein,   293 

phytolacca,  302 

pilocarpine,  310 

potassium  bichromate,  316 

potassium  permanganate,  317 
Dock,  yellow,  333 
Dogwood,   179 
Dropsy,  bryonin,  94,  96 

caffeine,  104 

calomel,  278 

cantharides,    127 

caulophyllin,   135 

iris,  255 

leptandrin,  268 

malarial,    quinine,    325 

pilocarpine,  309 

chimaphila,   142 

colocynthin,  171 

euonymin,  223" 

podophyllin,  313 

post-scarlatinal,  echinacea,  211 

renal    and    cardiac,    convallamarin. 

177 
eupatorium,  224 

scillitin,   341 

xanthoxylin,  366 
Drowning,  glonoin,  232 
Duboisia,  myoporoides,  57 
Duboisine  sulphate,  209 
Duodenal  catarrh,  echinacea,  210 

iridin,  255 

Dyscrasias,  nuclein,  293 
Dysentery,  ammonium  salicylate.  336 

bantisin,  7' 

berberine,  86 

capsicum,   132 

copper   arsenite,    178 

coto,  184 

echinacea,  210 

emetine,  216 

geranin,  229 

gossypin,  235 

hamamelis,  237 

iodoform,  253 

ipecac,  218 

juglandin,  263 


386 


INDEX. 


Dysentery,  leptandrin,  268 
lycopus,  271 
mercury,  279 
morphine,  283 
piperine,  312 
sanguinarine,  337 
senecin,  343 
sodium  benzoate,  84 
strychnine,  351 
tenesmus  of,  collinsonin,  169 
viburnin,  363 
xanthoxvlin,  365 
Dysmenorrhea,    arsenic,    47 
butyl  chloral  hydrate,  97 
caulophyllin,    135 
cerium  oxalate,   138 
cicutine,  150 
collinsonin,  168 
congestive,   ergot,    182 

hydrastinine,  245 
copper  arsenite,  178 
eupatorium,  225 
gelsemium,  227 
gold,  234 
helenin,  239 
iris,  255 
macrotin,  273 
nuclein,  295 
picrotoxin,    306 
podophyllin,  313 
sanguinarine,   337 
viburnin,  363 
xanthoxylin,  366 

Dyspepsia,  alcoholic,  capsicum,  132 
amylaceous,  diastase,  192 
arsenic,  46 
atonic,   juglandin,   263 

capsicum,  i?i 

euonymin,  223 

gold,  234 

helenin,  239 

sanguinarine,   337 
atropine,  69 
berberine,  86 
condurango,  174 
euonymin,  223 
fermentative,   echinacea,   210 

resorcin,   327 

fetid,  ammonium  salicylate,  336 
flatulent,   ipecac,   218 
irritative,  cerium  nitrate,  138 
hydrastine,  243 
leptandrin,  268 
lobelia,  270 
nervous,  rumicin,  333 

zinc  oxide,  371 
picric  acid,  304 
picrotoxin,    306 
podophyllin,  313 
potassium   bichromate,   316 


Dyspepsia,  quassin,  319 

rheumatoid,   macrotin,  273 
Dysphagia,  cicutine,  147 

cocaine,  159 
Dyspnea,  aspidospermine,  53,  55 

atropine,  69 

calcium  iodized,  115 

camphor  monobromide,  118 

cerium  oxalate,  138 

conyallamarin,  177 
Dysuria,  atropine,  69 

chimaphilin,    142 

gelsemium,  227 


EARACHE,  bryonin.  95 
Ecgonine,  157 
Echinacea,  210 
Eclampsia,  atropine,  66 

benzoic  acid.  181 

croton  oil,  187 

glonoin,  232 

lobelia,  270 

pilocarpine,  310 

veratrine,  359 
Ecthyma,  veratrine.  359 
Eczema,  arsenic,  47 

atropine,  69 

calcalith,  in 

echinacea,  211 

gelsemium,  227 

hydrastine,  243 

iris,  255 

juglandin,  263 

nuclein   295 

phytolacca,   302 

picric  acid,  304 

stypticin,  289 

veratrine,  359 

Edema,  pulmonary,  ergotin,  222 
Effusions,   serous,   salicylic  acid,  336 
Elaterium,  212 
Elecampane,  238 
Elephantiasis,   Iceland  moss.   139 

rumicin,  333 
Emissions,  atropine,  69 

cantharides,  126 
Emesis,  to  produce,   emetine,  216 

to  produce,  muscarine,  285 
Emmenagoer.   cauloph"llin,   135 

senecin,  343 
Emodin,  327 
Emphysema,  atropine,  69 

ipecac,  218 

Endocarditis,  digitalis,  205 
Endometritis,    chronic,    caulophyllin, 

135 

hydrastine,   243 
hvdrastinine,  245 
Euonymin,  223 


INDEX. 


387 


Euonymus  atropurpureus,  223 
Eupatorium  purpureum,  224 
Eupurpurin,  224 
Enteralgia,  chelidonin,  140 

codeine,  161,  162 

macrotin,  272 
Enteritis,  coto,   184 

lycopus,  271 

Enuresis,  nocturna,  atropine,  65 
collinsonin,  170 
iron,  259 
phytolacca,    303 
podophyllin,  313 
santonin,   340 
Epilepsy,  atropine,  66 

arsenic,  46 

bebeerine,   79 

bromides,  291 

camphor  monobromide,  119 

caulophyllin,  135 

cerium  oxalate,   138 

cicutine,  150 

cypripedin,  190 

gelsemium,  227 

glonoin  and  atropine,  231 

gold  bromide,  233 

hyoscyamine,  250 

hydrastinine,  246 

ipecac,  218 

lobelia,  270 

macrotin,  273 

nickel  bromide,  291 

nocturnal,  picrotoxin,  306 

parasite  causing,  363 

picrotoxin,  306 

santonin,  339 

strychnine,  352 

verbena,  362 

zinc  cyanide,  369 

zinc  oxide,  771 

zinc  yalerianate,  378 
Epistaxis,  geranin,  229 

gossypin,  23 5 

hamamelis,  237 

ipecac,  218 

lycopus,  271 

Epithelioma,  picric  acid,  304 
Erections,  feeble,  atropine,  69 

cornin,  179 
Erethism,  camphor  monobromide,  118 

cypripedin,  190 

zinc  valerianate,  378 
Ergot,   180 
Ergotin,  219 

dosage,  183 
Ergotinic  acid,  220 
Eruption,  delayed,  atropine,  70 
xanthoxylin,    366 

retrocession  of,  lobelia,  270 
Eruptive  diseases,  phytolacca,  302 


Erysipelas,  atropine,  69 

chloride  of  iron,  258 

echinacea,  210 

iron  chloride,  310 

lobelia,  270 

picric  acid,  304 

pilocarpine,    309 

rhus  tox.,  331 

salicylic  acid,  336 

veratrine,  359 
Erythema,  atropine,  69 

rhus  tox,  331 

veratrine,  359 
Erythrite.  223 
Erythroglucin,  223 
Erythrol  tetranitrate,  223 
Erythrorhetin,  327 
Eschscholtzia  californica,  337 
Eseridine,  300 

Eserine,  see  physostigmine,  300 
Ethoxy-caffeine,    107 
Eucaine,  158 
Exanthemata,  asclepidin,  51 

gelsemium,  227 

macrotin,  273 

nuclein,  295 

rhus  tox.,  331 

veratrine,  359 
Exhaustion,  cornin,   179 
Exophthalmic  goiter,  digitalin,  207 

lycopus,  272 

Exophthalmos,   nuclein,   295 
Expectorant,  cubebin,   188 

emetine,  216 

sanguinarine,  337 

scillitin,  341 

Eye,  swelling  of,  rhus  tox.,  331 
Eyestrain,  ftropine,  64 

macrotin,  273 


FAINTING,  glonoin,  231 
Fatigue,  caffeine,  105 

insomnia    of,     camphor    monobro- 
mide, 119 

Fecal  impaction,  codeine,  162 
Felon,  phytolacca,  303 
Fermentation,     alimentary,     salicylic 
acid,  335 

gastric,  iodofprm,  253 
quinine  salicylate,  337 
menthol,  276 
Fever,  adynamic,  rhus  tox.,  330 

alkalometric  treatment,  203 

bilious,  podophyllin,  313 

continued,  baptisin,  74 

exanthematic,  helenin.  239 

hectic,  chimaphila,  142 

intermittent,  caffeine,  105 

lobelia,  269 


388 


INDEX. 


Fever,  low,  capsicum,  133 

low  stage  of,  zinc  phosphide,  374 

macrotin,  273 

meaning  of,  358 

mountain,   echinacea,  210 

nuclein,  295 

puerperal,  ergotin,  222 
gelsemium,  227 
quinine,  325 
veratrine,  359 

remittent,  baptism,  74 
gelsemium,  226 

septic,  sodium  benzoate,  84 

sthenic,  gelsemium,  226 

strychnine,   353 

sulphocarbolates,  377 

typhoid,  gelsemium,  226 
nuclein,  293 

veratrine,  359 

Fibroids,  uterine,  ergotin,  221 
gossypin,  235 
hydrastin,  242 
Fish  berries,  305 
Fissure,  hydrastine,  243 

phytolacca,  302 
Fistula,  phytolacca,  302 
Flag,  blue,  254 
Flatulence,  ammonium  salicylate,  336 

capsicum,  133 

juglandin,  263 

menthol,  276 

physostigmine,  301 

picrotoxin,   306 

xanthoxylin,  365 
Fly  fungus,  63,  284 
Formalin   in   whooping-cough,    119 
Fraxinus,  86 
Freckles,  benzoic  acid,  83 

hamamelis,  237 
Fringe  tree,  143 


GALACTORRHEA,  ergot,  182 
Gall-stones,  boldine,  88 

formation  of,  88 

salicylic  acid,  335 

sodium  succinate,  344 
Gamma-homochelidonine,  337 
Gangrene,  pulmonary,  benzoin,  81 

echinacea,  210 

Gangrenous  tendency,  baptisin,  75 
Gas  poisoning,  glonoin,  232 
Gastralgia,  cannabis  indica,  122 

cocaine,  157 

codeine,  161,  162 

dioscorea,  208 

glonoin,  232 

macrotin,  272 

narceine,  287 

picrotoxin,  306 

zinc  cyanide,  369 


Gastric  catarrh,  capsicin,  131 
condurangin,  174 
gold,  234 
hydrastine,  243 
podophyllum,  313 
rhubarb,  328 
sanguinarine,  337 
strychnine,  351 
xanthoxylin,  365 
difficulties,  nuclein,  293 
dilatation,  berberine,  87 
iron,  259 
strychnine,  351 
hyperesthesia,  cocaine,  159 
irritability,  243 
troubles,  asclepidin,  51 
ulcer,  cannabis  indica,  122 
cocaine,  159 

condurango  and  iron,  174 
hydrastine,  243 
phytolacca,  303 
zinc  oxide,  371 
Gastritis,  lycopus,  271 
alcoholic,  hydrastin,  242 
chronic,  351 
dioscorea,  208 
emetine,  216 
ppdophyllin,  313 
zinc  oxide,  371 
Gastrodynia,  zinc  oxide,  371 
Gastrointestinal  disorders,  iridin,  255 
irritation,  gelsemium,   227 
torpor,  xanthoxylin,  366 
Gelsemin,   therapeutics,  225,   226 
Gelseminine,  225 

dosage,  229 

Gelsemium  sempervirens,  225 
dosage,  228 
synergists,  228 
specific  indications,  226,  228 
Genito-urinary    irritation,    chimaphi- 

lin,  142         ' 
Geranin,  229 

Geranium,  maculatum,  229 
Glaucoma,  physostigmine,  301 

pilocarpine,  310 
Glands,  enlarged,  iridin,  255 
phytolacca,  303 
rumicin,  333 

scrofulous,  juglandin,  263 
Glandular     enlargement,    chimaphila, 
142 

rumicin,  333 
Gleet,  cantharides,    126 
cubeb,  188 
geranin,  229 
hamamelis,  237 
hydrastine,  243 
senecin,  343 
Glonoin,  229 
dosage,  233 


INDEX. 


389 


Glycosuria,  ergot,  182 
Goiter,   iris,  255 
exophthalmic,  cannabis,  122 
digitalin,  207 
lycopus,  272 
sparteine,  345 
strophanthus,  347 
veratrine,  361 
Gold,  233 

dosage,  235 

Gonorrhea,  to  abort,  pilocarpine,  311 
berberine,  86 
boldine,  90 
chronic,   collinsonin,    170 

piperine,  312 
colchicine,  167 
cubeb,   188 
echinacea,   211 
gelsemium,  227 
hydrastin,  242,  243 
iris,  255 
hamamelis,  238 
phytolacca,   303 
senecin,  343 
Gossypin,  235 
Gossypium  herbaceum,  235 
Gout,  calcalith,   in 
colchicine,   166 
eupatorium,  224 
lithium  benzoate,  83 
pain,  atropine,  70 
salicylic  acid,  335 
Ground  holly,  142 
Gravel,  calcalith,  in 
collinsonin,  169 
lithium  benzoate,  83 
root,  224 
verbena,  362 
Gregory's  salt,  236 
Guarana,  99 
Guaranine,  236 
Gun  j  ah,  120 

1 

HAIR,  falling.  310 
cantharides,  126 

gray,  pilocarpine,  310 
Hamamelin,  237 

specific  indications,  238 
Hands  and  feet,  coldness  of,  bryonin, 

95 

Hasheesh,    120 
Haw,  black,  363 
Hay  fever,  atropine    70 

Calcalith,  HI 
Headache,  butyl  chloral  hydrate,  97 

caffeine,   104 

congestive,  ergotin,  221 
macrotin,  273 
veratrine,  361 


Headache,  constant,  cannabis  indica, 

122 

dull,  heavy,  podophyllin,  314 
of  eyestrain,  64 
gelsemium,  227 
gouty,  colchicine,   167 
miners',  iodoform,  254 
nervous,  cypripedin,  IQO 

zinc  yalerianate,   378 
neuralgic,  bryonin,  96 
picric    acid,    304 
reflex,  hydrastine,  243 
sick,  Calcalith,  in 
cannabis,   122 
iridin,  255 
lobelia,  270 
podophyllin,  314 
sanguinarine,  337 
veratrine,  361 

Heart,   bicycle,   collinsonia  and   cac- 
tus, 170 

dilatation  of,  berberine,  88 
diseases,  bryonin,  95 
caffeine,  104 
calcium  iodized,  115 
cannabis,  123 
collinsonin,  169 
convallamarin,  177 
digitalin,  2101 
dry  diet,  202 
glonoin,  231 
lycopus,  271 
podophyllin,  314 
sparteine,  345 
strophanthus,  347 
veratrine  ointment,  362 
zinc  cyanide,  370 

disorders,     functional,     scutellarin, 
342 

fattv.  iron,  259 
digitalis  in,  202,  203 
phytolacca,  ^03 
irritable,  strophanthus,  347 
rhythm,  irregular,  atropine,  70 
tonic,  ergotin,  222 
weakness,  barium  chloride,  77 
cactin,  98 
sparteine,  345 

Heat  exhaustion,  glonoin,  232 
Hebra's  paste,  48 
Helonias  dioica.  240 
Helenin,  238,  240 
Hematemesis,  ipecac,  218 
Hematocele,    retrouterine,     hydrasti- 

nine,  245 

Hematuria,  cannabis,  122 
cantharides,   126 
caused  by  ouinine,  326 
lycopus,  271 
senecin,  343 


390 


INDEX. 


Hemoptysis,   digitalin,  207 
gelsemium,  228 
gossypin,  235 
helenin,  239 
hydrastinine,  246 
hydrastin,  242 
iodoform.  253 
ipecac,  218 
lycopus,  271 
stypticin,   289 

vicarious,  sanguinarine,  337 
Hemorrhage,  atropine,  66 
capillary,   senecin,  343 
cornutine,  180 
digitalin,  205 
ergot,    182 
geranin,  229 
hamamelis,  237 
lycopus,  271 
passive,  258 

capsicum,  134 

collinsonia  and  hamamelis,   170 
post-partum,  ergot,  182 

glonoin,  232 
puerperal,  hydrastin,  242 

ipecac,  218 

from  tooth  cavity,  stypticin,  290 
urethral  and  vesical,  cornutine,  180 
uterine,   ergotin,   221 

hamamelis,   237 

hydrastine,   243 

stypticin,  289 

veratrine,  361 

Hemorrhoids,    bleeding,   atropine,   70 
capsicum,   132 
collinsonin,   169 
ergot,  182 
geranin,  229 
hamamelis,  237 
hydrastin,  242 
hydrastine,  2^3 
jalap,  262 
phytolacca,  303 
piperine,  312 
podophyllin,  314 
rhubarb,  328 
strychnine,   351 

Hepatic  congestion,  dioscorea,  208 
Hepatitis,  chronic,  boldo,  88 

iridin,  255 

podophyllin,  313 

sanguinarine,   337 
Hernia,   strangulated,  lobelia,  270 

hyoscyamine,   2.51 
Herpes,  rhus  tox.,  331 
phlyctenular,  veratrine,  359 
preputialis    iris,  255 
zoster,  atropine,  70 

iris,  2?5 

zinc  phosphide,   374 


Hiccough,  atropine,  70 

caulophyllin,    ii<; 

cicutine,  147 

cocaine,  159 

dioscorea,  208 

hyoscyamine,  250 

pilocarpine,  310 
Hoarseness,  capsicum,  134 

potassium  bichromate,  315 
Homatropine,  63 
Hyoscyamine,  249 

dosage,  250,  251 

vs.  morphine,  282 

poisoning,    treatment,    252 

therapeutics,  250 
Hour-glass  contraction,  caulophyllin, 

135 
Hydrastine,  241 

specific    indications,   244 
Hydrastinine,   245 
Hydrophobia,  curarine,   189 

echinacea,  211 

phytolacca,  303 
Hyoscine  hydrobromate,  247 
Hyoscyamus,  57 
Hyperemia,  spinal,  ergot.  182 
Hyperidrosis,  atropine,  68 

ergot,    182 
Hypnosis,  to  produce  cicutine,  149 

to  produce,  codeine,  161 
Hypnotics,  boldine,  90 

cannabis  indica,   122 

hyoscine,  248 

narceine,   287 
Hypochondria,  atropine,  70 

colchicine,   167 

cypripedin,   190 

gold,  234 

strychnine,  353 

zinc  cyanide,  370 
Hysteria,  atropine,  66,  70 

camphor   monobromide,    118 

caulophyllin,   135 

cicutine,  149 

cypripedin,  190 

gelsemium,    227 

gossypin,  235 

macrotin,  273 

pilocarpine,  310 

sanguinarine,   337 

scutellarin,  342 

viburnin,  364 

zinc  cyanide,  370 

zinc  oxide,  371 

zinc  valerianate,  378 
Hystero-epilepsy,  pilocarpine,  310 

ICELAND  Moss,  138 

Ignatia,   91 

Impaction,   fecal,  hyoscyamine,  251 


INDEX. 


391 


Impaction,  physostigmine,  301 

lobelia,  270 
Impetigo,  iris,  255 
Impotence,  atropine,  70 

cantharides,   126 

cornin,   179 

echinacea,  211 

eupatprium,  225 

functional,  gold,   234 

lecithin,  267 

piperine,  312 

strychnine,  351 

yohimbine,  367 

zinc  phosphide,  374 
Incontinence,   cantharides,    126 

ergotin,   221 

urinary,  collinsonin,   170 
Indigestion,  collinsonin,  169 

copper   arsenite,    178 

gastric    and    intestinal,    juglandin, 

263 

hydrastine,  243 

hydrastis,  244 

lycopus,  271 

papayotin,   299 

pepsin,  299 

podophyllin,  313 

'populin,  315 

quassin,  318 

rhubarb,  328 

salicin,  336 

strychnine,  350 
Indigo,  wild,  73 
Inflammations,  acute,  quinine,  325 

chronic,  bryonin,  94 

glandular,  echinacea,  210 

serous,  mercury,  278 
Influenza,   to   abort,   pilocarpine,  310 

atropine,  70 

camphor    monobromide,    119 

echinacea,  210 

gelsemium  with  strychnine,  229 

nuclein,  296 

salicin,  336 
Insanity,  cicutine,  149 
Insect  bites,  ipecac,  218 
Insomnia,  atropine,  70 

boldine,  90 

butyl  chloral  hydrate,  97 

cannabis   indica,    122 

caulophyllin,   136 

chelidonin,    140 

cicutine,  149 

codeine,   161 

convallamarin,    178 

cypripedin,  190 

gelsemium,  227 

hyoscine,  248 

lycopus,  271 

narceine,  287 


Insomnia,  scutellarin,  342 

zinc  phosphide,  373 

zinc  valerianate,  378 
Intestinal  antisepsis,  calomel,  278 

antiseptics,  action  of.  375 

atony,  leptandrin,  268 

catarrh,  hydrastine,  243 
podophyllin,  313 
quassin,  319 
sanguinarine,  337 

hyperemia,  juglandin,   263 

indigestion,  cornin,  179 
echinacea,  210 

obstruction,    atropine.    65 
Intestine,  lack  of  tone,  berberine,  86 
Intussusception,  lobelia,  270 
Inula  helenium,  238 
lodism,  113 
lodoform,  252 

dosage,  254 

intoxication,  test   for,  254 
Ipecac,  137 

specific  indications,  218 
Ippmoea  Jalapa,  261 
Iridin,  254 

dosage,  256 

Iridochoroiditis.  pilocarpine,  310 
Iris  versicolor,  254 
Iritis,  atropine,  64 

gelsemium,  227 

mercury,  278 

salicylic  acid,  335 

serosa,  pilocarpine,  310 

syphilitic,  iris,  255 
Iron,  256 

arsenate,  260 

benzoate,  81 

contraindications,  259 

dosage,   259 

iodide,  261 

phosphate,  261 

valerianate,  261 
Itch,  phytolacca,  -»O2 
Itching,  benzoic  acid,  83 

pilocarpine,  309 

zinc  cyanide,  370 


JABORANDI,  306 

Jaboridine,  306 

Jalapin,  261 

Japorine,  306 

Jaundice,  alcoholic,  hydrastin,  242 

boldine,  88 

catarrhal,  iodoform,  253 

ipecac,  218 

chipnanthin,    143 

iridin,  255 

itching  of,  pilocarpine,  309 


392 


INDEX. 


Jaundice,    leptandrin,    dioscorea    and 
chionanthus,  268 

malarial,  quinine,  105 

podophyllin,  314 

spasmodic,  atropine,   105 

xanthoxylin,   365 
Jequirity,   134 
Jervine,  354,  357 
Juglandin,    262 

dosage,  264 
Juglans  cinerea,  262 
Juniper,  132 

KERATITIS,  atropine,  71 

Kidney,  congestion,  capsicum,  132 

Kirschwasser,  369 

Kola,  99 

Koussein,  264 

LABOR,  atropine,  71 

cornutine,    180 

ergotin,  221 

gelsemium,  227 

gossypin,  235 

hydrastin,  242 

macrotin,  273 

pains,  to  excite,  cornutine,  180 
caulophyllin,  135 
macrotin,  274 
viburnin,  364 
Lactorrhea,  65 
Ladies'  slipper,   190 
La  grippe,  nuclein,  296 
Laloneurosis,  duboisine,  209 
Laryngeal    irritation,    potassium     bi- 
chromate,  316 

tuberculosis,  cocaine,  159 
Laryngismus  stridulus,  71 
hyoscyamus,   250 
ipecac,   218 
gold,  234 
Laryngitis,   benzoin,  81 

chronic,  collinsonin,  -169 

emetine,  216 

lobelia,  270 

phytolacca,  302 

pilocarpine,   309 

potassium   bichromate,   316 

spasmodic,  cicutine,  147 

tubercular,  cantharides,  127 

zinc  cyanide,  370 
Landanine,  347 
Lecithin,  265 

Leg  weariness,  zinc  phosphide,  374 
Leontin,  134 
Leprosy,  rumicin,  333 
Leptandrin,  268 
Leptandra   Virginica,   268 
Leucocythemia,  menispermin,  275 


Leucorrhea,  bebeerine,  79 
cantharides,  126 
caulophyllin,  135 
collinsonin,   168 
echinacea    211 
ergotin,  18? 
eupatorium,  225 
geranin,  229 
hamamelis,  237 
hydrastin,  242,  243 
iris,  255 
phytolacca,  303 
senecin,   343 
uterine,  macrotin,  273 
viburnin,  364  ^ 

Leukemia,  picric  acid,  304 
Lids,  edema  of,  rhus  tox.,  331 
Lily  of  the  valley,  176 
Lime,   "iodide"  of,  112 
Lithium  benzoate,   83 
Lithemia,  macrotin,  274 

pipsissewa,  142 
Liver  diseases,  boldine,  88,  91 

bryonin,  95 

hyperemia  of,   phytolacca,  303 
torpid,  bryonin,  96 
chionanthin,    143 
euonymin,   223 
gold,  214 
iridin,  255 
juglandin,    263 
leptandrin,  268 
podophyllin,  313 
quassin,  319 
sanguinarine,   337 
sodium  benzoate,  84 
Lobelia  inflata,  269 
Lobelin,  269 
dosage,  271 

specific  indications,  270 
Locomotor  ataxia,  atropine,  71 
cannabis  indica,   122 
yohimbine,   367 
zinc  phosphide,  373 
Lumbago,  atropine,  71 
euonymin,   224 
gelsemium,  228 
juglandin,  263 
macrotin,   272 
rhus  tox.,  331 
salicylic  acid,  336 
xanthoxylin,  365 
Lupus,   cantharidin,    126 

hydrastine,  243 
Lycopin,  271 

specific  indications,  272 
Lycopus    virginicus,    271 
Lymohatic    enlargements,    corydalin, 
183 
phytolacca,  303 


INDEX. 


393 


MACROTIN,  272 

dosage,  274 

specific  indications,  274 
Malaria,  alkalometric  treatment,  324 

arsenic,  46 

bebeerine,  79 

berberine.  86,  87 

calomel,  27Q 

capsicum,   132 

chionanthin,   143 

cornin,   179 

dioscorea,  208  ' 

echinacea,  210 

euonymin,  223 

gelsemium,  226 

ipecac,  218 

iris,  255 

juglandin,  263 

leptandrin,  268 

macrotin,  273 

picric  acid,  304 

piperine,  311 

podophyllin,  313 

quassin,  319 

quinine,  323,  324 

salicin,  336 

verbenin,  362 

xanthoxylin,   366 
Malignant  pustule,  yeratrine,  359 
Malnutrition,   lecithin,  267 
Mammary  pain,  caulophyllin,  135 
Mammitis,  bryonin,  95 

echinacea,  211 
Manec's  paste,  48 
Mania,  acute,  hyoscyamine,  250 

atr opine,  71 

cannabis  indica,  122 

digitalin,  205 

gelsemium,  227 

pilocarpine,  310 

a  potu,   cocaine,    158 

puerperal,  iron,  259 

veratrine,  361 
Maraschino,  369 
Marasmus,  lecithin,  267 
Marsden's  paste,  48 
Mastitis,  acute,  phytolacca,  303 

hamamelis,   237 

macrotin,  273 
Mastodynia,  macrotin,  273 
Mate,  99 
May  apple,  312 
Meadow  saffron,   163 
Measles,  atropine,  71 

pilocarpine,  311 

quinine,  326 
Melancholia,  atropine,  71 

cocaine,  159 

codeine,   161 
Meniere's  disease,  gelsemium,  228 


Meniere's  disease,  quinine,  326 

salicylic   acid,   335 
Meningitis,   cerebrospinal,   echinacea, 

210 
hyoscine,  248 

pneumonia,  hyoscine,  248 

tuberculous,  148 
Menispermine,  274 
Menopause,  cicutine,   149 
Menorrhagia,  atropine  in,  71 

bebeerine,  79 

berberine,  86 

cannabis  indica,  122 

collinsonin,   168 

gold,  2^4 

gossypin,  235 

senecin,  343 

stypticin,  289 

virgins',  hydrastinine,  245 
Menstrual  cramps,  caulophyllin,  135 

irregularities,  senecin,  343 

suppression,  verbena,  362 
Menstruation,    vicarious,    collinsonin, 

168 
Mental  depression,  cypripedin,  190 

overwork,    strychnine    valerianate, 

353 

Menthol,  275 
Mercurialism,  iridin,  255 

iron,  258 
Mercury,  276 

contraindications,  279 

physiologic  action,  277 

poisoning,  treatment,  279 

therapeutics,  278 

toxicology,  276 
Methyl-iodine-strychnine,  189 
Metritis,  caulophyllin,  135 

cornutine,  180 

gelsemium,  227 

gold,  234 

hydrastine,  243 

viburnin,  363 
Metrorrhagia,   gossypin,  235 

hydrastine,  243 

stypticin,  289 
Micturition,  painful,  eupatorium,  224 

senecin,  343 
Migraine,  cannabis  indica,  122 

cocaine,  159 

ergot,  182 

picrotoxin,  306 
Mint,  oil  of,  275 
Memordica,    elaterium,    212 
Morning  languor,  avenin,  73 
Morphine,  279 

see  Gregory's  salt,  236 

habit,  avenin,  73 
cannabis,    123 
cocaine  in,  158 


394 


INDEX. 


Morphine  habit,  gelsemium,  227 
glonoin,   232 
hyoscine,  248 
physostigmine,  301 
treatment,  284 

physiologic  and  toxic  actions,  280 
poisoning,  atropine,  66 
therapeutics,  281 
Moth  patches,  benzoic  acid,  83 

caulophyllin,    136 
Mucoenteritis,  potassium  bichromate, 

316 
Mumps,  phytolacca,  303 

pilocarpine,  310 
Muscarine,  6?,  120,  284 
Mushroom  poisoning,  285 

strychnine,  350 
Myalgia,  atropine,  71 
calcalith,  in 
gelsemium,  227 
hydrastine,  243 

rhus  tox.,  with  cimicifuga,  331 
salicylic  acid,  335 
veratrine,  361 
Mydriatic,  atropine  as,  63 
Myelitis,  atropine,  71 
Myocarditis ;   caffeine,   104 

NARCEINE,  285 

therapeutics,  287 
Narcomania,  cannabis,  123 
Narcosis,  to  produce,  chelidonin,  140 
Narcotine,  288 
Nasal  troubles,  calcalith,  112 
Nausea,  cerium  oxalate,  138 
iris,  256 
lobelia,  270 
picrotoxin,  306 
and  vomiting,  ipecac,  218 
Nectandra,  78 

Nephritis,  acute,  cantharides,  126 
atropine,  71 
benzoic  acid,  81 
chronic,    cantharides,    127 
caulophyllin,   135 
colocynthin,  171 
convallamarin,    177 
desquamative,  hydrastin,  242 

iron,  259 

interstitial,   glonoin,   231 
gold,  234 
veratrine,  360 
pilocarpine,  309 
Nephrolithiasis,  calcalith,   in 
Nervous  debility,  avenine,  73 
diseases,  arsenic,  46 
exhaustion,  camphor  monobromide, 

IIQ 

irritation,  scutellarin,  342 
pain,  cannabis,   122 


Nervousness,  cypripedin,  190 

gelsemium,  227 

scutellarin,  ?<t2 

zinc  valerianate,  378 
Neuralgia,  asclepidin,  51 

atropine,  66 

butyl  chloral  hydrate,  96 

caffeine,  105 

cannabis  indica,   122 

cicutine,   147 

convallamarin,    178 

cypripedin,   190 

dioscorea,  208 

gelseminine,  228 

gelsemium,  227 

hyoscyamine,  250 

iodoform,   253 

iron,  258 

laryngeal     and     pharyngeal,    xan- 
thoxylin,  365 

macrotin,  272,   273 

narceine,  286 

quinine,   325 

salicylic  acid,  335 

veratrine,  359 

zinc  cyanide,  369 

zinc  oxide,  371 

zinc  phosphide,  373 

zinc  valerianate,  378 
Neurasthenia,  373 

arsenic,   46 

cactin,  99 

gold,  234 

iron,  259 

lecithin,   267 

quinine,  326 

strychnine  valerianate,  353 

xanthoxylin,  366 

yohimbine,  367 

zinc  phosphide,  373 
Neuro-Lecithin,  see  Lecithin,  265 
Neuroses,  iron,  258 

salicylic  acid,  335 
Nickel  bromide,  290 
therapeutics,  291 
Night  coughs,  calcium  iodized,  115 

terrors,  hyoscine,  248 
Night-sweats,  atropine,  65 
ergot,  182 
euonymin,  223 
hydrastin,  242 
of  phthisis,  quinine,  326 
picrotoxin,  306 
zinc  oxide,  371 

Nipples,  fissured,  hydrastin,  242 
Nitroglycerin,  see  glonoin,  229 
Noyan,  368 
Nuclein,  292 

administration,  297 

dosage,  298 


INDEX. 


305 


Nuclein,  physiologic  action,  292 

therapeutics,  292 
Nux  vomica,  91,  93,  347 
Nymphomania,     camphor     monobro- 

mide,  118 

gold,  234 

zinc  valerianate,  378 

OAT,  common,  72 
Obesity,  atropine,  71 

phytolacca,    303 

Obstruction,  intestinal,  lobelia,  270 
(Edema  of  glottis,  atropine,  70 

pilocarpine,  310 
Oliguria,  scillioicrin,  340 
Opacities,   vitreous,  pilocarpine,  310 
Ophthalmia,  baptisin,  74 

bebeerine,  79 

capsicum,  134 

geranin,  229 

hamamelis,  237 

rheumatic,  veratrine,  359 

scrofulous,  147 
Opium,  279,  285 

poisoning,  treatment,  284 
Orchialgia,  caulophyllin,   136 
Orchitis,   atropine,  71 

chronic,  bryonin,  94 

phytolacca,  302 
Os,  rigid,  lobelia,  270 
Otalgia,  atropine,  71 
Otitis  media,  hydrastine    243 

pilocarpine,  310 
Otorrhea,  hydrastin,  242 
Ovaralgia,  macrotin,  273 

zinc  valerianate,  378 
Ovarian  congestion,  hamamelis,  237 

irritation,  viburnin,  364 

neuralgia,   gelsemium,   227 

pain,  bryonin,  95 
caulophyllin,   135 
codeine,  161 
Ovaritis,  caulophyllin,   135 

gelsemium,  227 

phytolacca,  303 
Over-eating,  rhubarb,  328 
Oxytocic,  atropine  as,  67 

caulophyllin,    135 
Ozena,  papayotin,  299 

PAIN,  abdominal,  leptandrin,  268 
ataxic,    pilocarpine,   310 

santonin,   340 
burning,  rhus  tox.,  330 
cancer,  narceine,  286 
colicky,  eupurpurin,  225 
dorsal,  xanthoxylin,  366 
false,  viburnin,  364 
gallstone,  282 


Pain,  gastric,  menthol,  276 
hepatic,   leptandrin,    268 
inflammatory,  morphine,  282 

narceine,  287 
infantile,  codeine,  162 
intestinal,  codeine,  161 
lumbar,  viburnin,  363,  364 
mediastinal,  macrotin.  273 
morphine,  281 

muscular,     potassium     bichromate, 
3i6 

macrotin,  274 
colchicine,  167 
xanthoxylin,  365 
orbital,  macrotin,  273 
ovarian,  2T>i 
codeine,  161 
colocynthin,  171 
pectoral     and     subscapular,    iridin, 

255 
pelvic,   gossypin,  235 

salicin,   336 
spasmodic,  atropine,  64 

hyoscyamine,  251 
thigh,  xanthoxylin,  366 
testicular,  macrotin,  273 
uterine,  macrotin,  274 
vesical,  codeine,  162 
zinc  cyanide,  370 

Palpitation,    camphor    monobromide. 
118 
cardiac,  veratrine,  359 

zinc  cyanide,  369 
Palsy,   shaking,  picrotoxin,  306 
Panchymagogus  que  roetanus,  236 
Pancreatic  disorders,  iridin,  255 
Pa  paver   somni  forum,   279 
Papayotin,  298 
Papoose  root,  134 
Paralysis,   atropine,   71 
agitans,  cocaine,  159 

curarine,  189 
hyoscyamine,  251 
picrotoxin,  306 
scutellarin,   342 
viburnin,  364 
capsicum,  133 
general,  gold,  234 
glottic,  xanthoxylin,  365 
infantile,  veratrine,  361 
post-rheumatic,  rhus  tox.,  331 
strychnine,  352 
vesical,  ergot,  182 
zinc  phosphide,  373 
Parametritis,   hydrastine,   243 
Parevia,  78 

Paresis,  zinc  phosphide,  373 
Parilla,  yellow,  274 
Parotitis,  phytolacca,  302 
rhus  tox.,  331 


396 


INDEX. 


Paullinia  sorbilis,  236 
Pawpaw,  298 

Pediculosis,  veratrine,  361 
Pemphigus,  veratrine,  359 
Pepper,  black,  311 
Pepsin,  299 
Pericarditis,  bryonin,  95 

digitalin,  20*; 

Peridentitis,  xanthoxylin,  365 
Perineum,  rigid,  lobelin,  270 
Peritonititis,   bryonin,   95 
Peri  typhlitis,  codeine,  162 
Pertussis,  atropine,  71 

benzoic  acid,  81 
Petit  mal,   viburnin,  364 
Peumus  boldo,  88 
Phaeoretin,  327 
Phagadena,  baptisin,  74 

echinacea,  211 
Pharyngitis,  calcium  iodized,  115 

capsicum,   134 

caulophyllin,  135 

follicular,   nuclein,  296 

hamamelis,  237 

hydrastine,  243 

sanguinarine,  338 

xanthoxylin,  36^ 

Phlegmasia  dolens,  echinacea,  21 1 
hamamelis,  237 
macrotin,  273 

Phosphorus,  antidotes,  373 
Photophobia,    cicutine,    147 

codeine,  161 

rhus  tox.,  331 
Phthisis,  arsenic,  46 

bebeerine,  79 

cannabis,   123 

cocaine,  159 

cough  of,  emetine,  216 
macrotin,  273 
zinc  cyanide,  370 

creasote,    185 

dyspnea  of,  convallamarin,  178 

echinacea,  211 

fibroid,  ipecac,  218 

gold  and  sodium,  235 

helenin,  239 

hamamelis,  237 

incipient,  cetrarin,  139 

iodoform,  253 

iron,  259 

iron  arsenate,  260 

lecithin,  267 

night-sweats  of,  pilocarpine,  210 

nuclein,  292,  296 

rumicin,  333 

strychnine,  352 

zinc  sulphocarbolate,   377 
Phycite,  223 
Physostigmine,  300 


Physostigmine,   dosage,  302 

venenosum,  300 
Phytolacca  decandra,  302 
Phytolaccin,  302 

dosage,  303 

specific  indications,  303 
Picric  acid,  303 

dosage,  305 

therapeutics,  304 
Picropodophyllin,  312 
Picrotoxin,  305 
Piles,  capsicum,   132 

collinsonin,  169 
Pill,  compound  cathartic,  172 
Pilocarpidine,  306 
Pilocarpine,  306 

antagonists  and  incompatibles,  308 

dosage,  311 

therapeutics,  307 
Pilocarpus  microphyllus,  306 
Piper  cubeba,  187 

nigrum,  311 
Piperine,  311 
Pipsissewa,  142 

Pityriasis  versicolor,  benzoic  acid,  83 
Plenck's  depilatory,  148 
Plethora,  veratrine,  361 
Pleurisy,  asclepidin,  51 

bryonin,  94,  95 

digitalin,  205 

gelsemium,  227 

Iflbelia,  270 

pilocarpine,  309,  310 

rheumatic,  colchicine    167 
Pleurodynia,  atropine,  71 

macrotin,  2T3 

salicylic  acid,  335 

veratrine,  361 
Pneumonia,   asclepidin,   51 

atropine,  71 

benzoic  acid  with  camphor,  81 

bryonin,  94,  95 

cactin,  99 

capsicum,  133 

catarrhal,   caulophyllin,    136 

chronic,  helenin,  240 

cocaine,   158 

digitalin,  205 

gelsemium,  227 

glonoin,  232 

lobelia,  270 

pilocarpine,  309 

purulent,  creasote,  186 

salicylic  acid,  336 

sanguinarine,  338 

sodium   benzoate,   84 

strychnine,   353 

typhoid,  331 

quinine,   325 

veratrine,  359 


INDEX. 


397 


Podophyllin,  312 

dosage,  314,  315 

specific  indications,  313 

synergists,  314 
Podophyllotoxin,  312 
Podophyllum  peltatum,  312 
Poke,  302 
Pollutions,     camphor     monobromide, 

118 

Poplar,  white,  315 
Populin,  315 

Populus  tremuloides,  315 
Post-partum   hemorrhage,  ergotin,  221 

glonoin,  232 

Potassium   bichromate,  315 
specific  indications,  316 

cantharidate,  129 

permanganate,  316 
Pregnancy,  nuclein,  297 

quinine  in,  326 
Priapism,  camphor  monobromide,  118 

caused  by  cantharidin,  128 

veratrine,  361 
Prince's  pine,   142 
Proctitis,  subacute,  collinsonin,  169 
Prolapsus  ani,  hamamelis,  237 

uteri,  collinsonin,  168 

hamamelis,  237 
Prostatitis,  acute,  cubebin,  188 

chronic,  pipsissewa,   142 
Prostatorrhea,  atropine,  71 

iris,  255 

senecin,   343 
Protopine,  139,  337 
Protoveratrine,  358 
Pruritus,  atropine,  71 

brucine,  93 

cicutine,  148 

colchicine,   167 

vulvse,  collinsonin,  168 

rhus  tox.,  331 
Pseudojervine,  354 
Pseudoleukemia,  iron,  259 
Psoriasis,  phytolacca,  302 
Puerperal  fever,  benzoic  acid,  81 

veratrine,  359 
Pulmonary     affections,      pilocarpine, 

309 

gangrene,  ammonium  salicylate,  336 
Pupil,  to  contract,  physostigmine,  301 
Purpura,  ergot,  182 
Pyelitis,  cantharides,  126 

gold,  234 

pipsissewa,  142 
Pyemia,  quinine,  325 
Pyrosis,  cornin,   179 

QUASSIA  AMARA,  317 
Quassin,  317 
Quebrachamine,  53,  54 


Quebrachine,  53,  54 
Quebracho,  53 
Queen  of  the  Meadow,  224 
Quinine,  320 

arsenate,  324 

vs.  cinchonidine,   150 

contraindications,  326 

incompatibles,  323 

physiologic  action,  321 

ringing  in  ears,  prevented  by  bro- 
mide, 326 

synergists,  323 

therapeutics,  323 
Quininism,  cornin,  179 
Quinsy,  echinacea,  210 

nuclein,  296 

RABIES,  cicutine,  147 

Rachitis,  iron,  259 

Ragwort,   senecin,   342 

Redness  of  skin,  rhus  tox.,  330 

Resorcin,  327 

Restlessness,  scutellarin,  342 

rhus  tox.,  330 
Rectal  ulcer,  atropine,  71 
Retina,    detachment    of,    pilocarpine, 

310 

Rhein,  327 
Rheotannic  acid,  327 
Rheumic  acid,  327 
Rheumatism,  acute,  benzoic  acid,  81 

asclepidin,  51 

atropine,  72 

potassium  permanganate,  317 

rhus  tox.,  330,  331 
sodium  benzoate,  84 

benzoic  acid,  83 

bryonin,  94,  95 

calcalith,  in 

caulophyllin,  135 

chronic,  iris,  255 
phytolacca,  302 
pipsissewa,  142 
potassium  bichromate,  316 

colchicine,  167 

eupatorium,  224 

macrotin,  272 

muscular,    xanthoxylin.    365 

nuclein,  206 

podophyllum,   313 

resprcin,  327 

salicin,  336 

salicylic  acid,  .-ne 

sanguinarine,  337 

veratrine,  ?*>9 
Rheumic  acid,  327 
Rheumatoid    arthritis,    salicylic    acid, 

335 

Rhinitis,  hydrastine,  243 
hypertrophic,  sanguinarine,  337 


398 


INDEX. 


Rhubarb,  327 

specific  indications,  329 
Rhus  poisoning,  lobelia,  270 

tox.,  329 

remedies  for  poisoning,  332 
specific  indications,  330,  331 
Rigid  os,  gelsemium,  227 

lobelia,  270 

Ringworm,   croton  oil,   187 
Rosacea,  stypticin,  289 
Roseola,   atropine,   72 
Rubijervine,  354 
Rumex  crispus,  7,33 
Rumicin,  333 

specific  indications,  313 
Rumination,  arsenic,  46 
Rupia,  iris,  255 
Rusma  Turcarum,  48 


SABADINE,  354 
Sabadinine,  354 
Saffron,  meadow,  163 
Salicin,  315,  333 
Salicylic  acid,  333 

poisoning  by,  335 
Salivation,  276 
Salix  nigra,  333 
Salpingitis,  echinacea,  211 

gelsemium,  227 
Sanguinaria    Canadensis,    337 
Sanguinarine,   337 
dosage,  338 

specific  indications,  338 
Santonin,  338 

administration,   770 
Sapremia,  quinine,  326 

salicylic  acid,  336 
Satyriasis,  zinc  valerianate,  378 
Scabies,  phytolacca,  302 
Scarlatina,  arsenic  a  prophylactic,  47 

atropine,  72 

Scarlet  fever,  baptism,  74 
benzoic  acid,  81 
bryonin,  94 
echinacea,  210 
pilocarpine,  311 
piperine,  312 

potassium  permanganate,  317 
salicylic  acid,  336 
sore  throat,  sanguinarine,  338 
Sciatica,  atropine,  72 
codeine,  161 
colocynthin,    171 
croton  oil,  187 
gelsemium,  227 
macrotin,  274 
narceine,  286 
rhus  tox.,  331 
veratrine,  359 
zinc  valerianate,  378 


Scilla  maritima,  340 

Scillain,  340 

Scillin,  340 

Scillitin,  340 

Scillipicrin,  340 

Scillitoxin,  340 

Scleritis,  colchicine,   167 

Sclerosis,  multiple,  veratrine,  359 

spinal,   gold,   234 
Scopolia,    58 
Scrofula,    chimaphilin,    142 

corydalin,    183 

hydrastine,  243 

iridin,  255 

iron  arsenate,  260 

iron  iodide,  261 

juglandin,  263 

menispermin,  275 

phytolacca,  302 

podophyllum,  313 

potassium  bichromate,  315 

rumicin,  333 

sanguinarine,  337 

verbena,  362 

xanthoxylin,  365 

zinc  sulphocarbolate,  377 
Scurvy,  atropine,  72 

rumicin,  333 
Scutellarin,  342 
Scutellaria  lateriflora,  342 
Sea-sickness,  atropine,  72 

pepsin,  299 

rhubarb,  328 

Seborrhea,  hydrastine,  243 
Secretion,  to  modify,  atropine,  65 
Senecin,  342 
Senecio  jacoboea,  342 
Senile  degenerations,  zinc  phosphide, 

374 

Senility,  gold,  234 
Sepsis,  baptism,  75 

digitalin,   207 

Septicemia,  echinacea,  210 
nuclein,  297 
salicylic  acid,  336 
Serous  exudates,  bryonin,  95 
inflammations,  codeine,   162 
Sexual  ardor,  to  diminish,  bromides, 

291 

atony,  senecin,  343 
irritation,    camphor    monobromide, 
118 

caulophyllin,  135 
verbena,  362 
lassitude,  gossypin,  235 
sedative,   populin,    715 
weakness,    strychnine,   351 
Skin  diseases,  chronic,  juglandin,  263 
iron  arsenate,  260 
scaly,  rhus  tox.,  331 
Skullcap,  342 


INDEX. 


399 


Sleep,  mornhine,  282 

Sloe,  363 

Smallpox,  baptisia,  75 

cocaine,  159 

echinacea,  211 
Sneezing,  arsenic  for,  46 

atropine,  72 

Snuffles,  calcium  iodized,  115 
Smallpox,  macrotin,  273 

pilocarpine,  311 

salicylic  acid,  336 
Snake  bites,  echinacea,  210 
gold,  234 
pilocarpine,  310 
strychnine,  350 
Sodium  benzoate,  84 

succinate,  344 
Somnambulism,    hyoscine    and    cicu- 

tine,  248 
Sophorine,  73 
Sore  mouth,  nursing,  echinacea,  210 

nursing,  juglandin,  263 
Soreness,  muscular,  hamamelis,  237 
Sore  throat,  capsicum,  134 
caulophyllin,    135 
hamamelis,  237 
lobelia,  2"o 

ministers',  collinsonin,   169 
rumicin,  333 
Sparteine,  345 
Spasm,  bowel,  gelsemium,  227 

capsicum,  134 

intestinal,  xanthoxylin,  365 

lobelia,  270 

muscular,  cicutine,   148 

palpebral,  147 

urinary,  gelsemium,  227 

uterine,  emetine,  216 

vesical.    cannabis,    122 
Spasmodic  conditions,  atropine,  64 
Spermatorrhea,    atropine,    72 

avenine,  73 

camphor  monobromide,   118 

cantharides,   126 

collinsonin,  169 

cornutine,  180 

gelsemium,  227 

gold,  234 

hydrastine,  243 

iris,  255 

strychnine  valerianate,  353 

viburnin,  364 

zinc  valerianate,  378 
Sphacelinic  acid,  180,  220 
Sphacelotoxin.    220 
Spleen,  enlarged,   berberine.  86 
ergot,   182 
quinine,  325 

hyperemia,  phytolacca,  303 
Splenic  disease,  iris,  255 


Sprains,  hamamelis,  237 

Squaw  root,  134 

Squirting    cucumber,    see    elaterium, 

212 
Sterility,   senecin,  343 

viburnin,  364 
Stomatitis,  aphthous,  hvdrastine,  243 

caulophyllin,   135 

hydrastin,   242 

phytolacca,  302 

ulcerative,  echinacea,  210 
Stone-root,    168 
Stramonium,  57 
Strangury,  codeine,  162 

senecin,  343 
Strophanthin,  346 
Strophanthus  hispidus,  346 
Struma,  nuclein,  297 
Strychnine,  347 

absorbed  from  rectum,  349 

antagonists,  350 

antidote,  tannic  acid.  350 

arsenate,  353 

dosage,  302 

hypophosphite,  353 

poisoning,  cicutine,  147 

therapeutics,  350 

toxicology,  348 

valerianate,  353 
Strychnos  nux  vomica,  347 
Stypticin,  289 

Subinvolution,    phytolacca,    303 
Sulphocarbolates,  375 
Sunburn,  hamamelis,  237 
Sunstroke,  atropine,  72 

caffeine,   105 
Sweats,  colliquative.  ergotin,  222 

excessive,  bebeerine,  79 

profuse,  picrotoxin,  306 
Syncope,  atropine,  72 

glonoin,  231 
Sycosis,  hydrastine,  243 

phytolacca,  302 
Synovitis,  bryonin,  95 

rhus  tox.,  332 
Syphilis,   arsenic,   47 

bebeerine,  79 

corydalin,    183 

echinacea,  21 I 

gold,   235 

iodoform,  253 

iron,  258 

iron  iodide,  261 

mercury,  277 

nuclein,  297 

phytolacca,  302 

podophyllin,  313 

potassium    bichromate,    315 

rumicin,  33^ 

xanthoxylin,  365 


400 


INDEX. 


TAKA  DIASTASE,  IQI 
Tan,    hamamelis,    237 
Tapeworm,  koussein,  264 

Tea,  99 

Teething,   cypripedin,   190 

Tenesmus,   vesical,   hyoscyamus,   250 

populin,  315 
Tetanocannabine.   120 
Tetanus,   atropine,   72 

cicutine,  147 

curarine,  189 

gelsemium,  227 

lobelia,  269 

physostigmine,  301 

veratrine,  359 
Thebaine,  347 

Tic    douloureux,     butyl    chloral    hy- 
drate, 97 
cicutine,  147 
gelsemium,  227 
Tinea,  sanguinarine,  337 

capitis,    phytolacca,    302 
Tinnitus  aurium,  gelsemium,  227 
Tobacco,  58 

heart,  sparteine,  345 

neuroses,  caffeine,  105 
Tonics,  iron,  257 
Tonsillitis,  atropine,  72 

baptisin,  74 

capsicum,   134 

echinacea,  210 

hamamelis,  237 

nuclein,  293,  296 

potassium  bichromate,  316 

veratrine,  361 
Toothache,  capsicum,  134 

gelsemium,  227 

rhus  tox.,  330 

xanthoxylin,  365 
Torpor,  nervous,  caffeine,   105 
Torticollis,  macrotin,  272 

rhus  tpx.,  331 

salicylic  acid,  335 

xanthoxvlin,   365 
Toxicodendrol,  329 
Toxiresin,   197 
Tracheitis,   phytolacca,   302 
Trachoma,  hydrastine,  243 

potassium  bichromate,  316 
Tremors,  alcoholic,  picrotoxin,  306 

hyoscyamine,  250 

scutellarin,  342 

senile,  cocaine,  159 
veratrine,  359 
hyoscyamine,  250 
Tri-methylxanthine,  99 
Trinitrophenol,  304 
Trismus,  atropine,  72 
Tubercular  abscesses,  echinacea,  211 

diathesis,    echinacea,   211 


Tubercular,  laryngitis,  cantharides,  127 

meningitis,  148 
Tuberculosis,  creasote,  185 
iodoform,  253 
lecithin,  26*7 
nuclein,   292 
papayotin,  299 
potassium  cantharidate,  129 
sulphocarbolates,  377 
Tumors,  fraxinus,  86 
abdominal,  codeine,  162 
mammary,  chimaphila,  142 
Turkey  corn,  183 

Typhoid  fever,  ammonium  benzoate, 
83 

atropine,  72 
baptisin,  74 
nuclein,  291,  296 
quinine,  325 
salicylic  acid,  336 
sodium  benzoate,  84 
sulphocarbolates,  376 
veratrine,  359 
zinc  sulphocarbolate,  376 
pneumonia,  echinacea,  210 
Tympanites,  xanthoxylin,  365 
Typhlitis,  echinacea,  210 
Typhus,  camphor  monobromide,   118 


ULCER,  atropine,   72 

Ulcers,   anal,   hydrastine,  243 

benzoin,  83 

corneal,   hydrastine,   243 
potassium,  bichromate,  316 

faucial,  phytolacca,  302 

gastric,  cocaine,  159 
condurango,  174 

geranin,  229 

hydrastin,  242 

hydrastine,  243 

indolent,   nuclein,  292 

iodoform,  253 

lycopus,  271 

mouth,  juglandin,  263 

red-edged,   rhus  tox,  331 

rectal,    hydrastine,    243 

syphilitic,   hydrastine,   243 

varicose,   phytolacca,  302 

xanthoxylin,  86 
Ulexine,  73 
Urea  elimination,   increased   by  bol- 

dine,  89 
Uremia,  benzoic  acid,  81,  82 

chronic,  82 

Urethral    irritation,   chimaphilin,    142 
Urethritis,  caulophyllin,   135 
Uric  acid,  benzoates,  83 

diathesis,  Calcalith  in,  in 
lecithin,    267 


INDEX. 


401 


Uricacidemia,  chimaphila,  142 

colchicine.  167 
Urinary  ailments,  82,  83 

burning,  rhus  tox.,  331 
Urination,  painful,  senecin,  343 
Urine,   acid,  barosmin,  78 

ammoniacal,  benzoic  acid,  81,  83 

retention  of,  caulophyllin,  135 
Urticaria,  atropine,  72 

benzoic  acid,  83 

stypticin,  289 

veratrine,  359 

Uterine  congestion,  hamamelis,  237 
viburnin,   363 

diseases,   collinsonin,    168 

disorders,  iris,  255 

fibroids,  calcium  iodized,   114 
ergotin,  221 

hemorrhages,   cannabis   indica,    122 

inertia,  ergotin,  221 
gossypin,   235 

irritability,    eupatorium,   225 

pain,   cannabis  indica,   122 
viburnin,  363 

reflexes,  zinc  valerianate,  378 

spasms,  atropine,   64 

tenderness,  caulophyllin,  135 

tonic,  viburnin,  363 
Uterus,    subinvolution   of,   berberine, 

86 


VAGINISMUS  collinsonia,  170 
Vaginitis,  hydrastin,  242 
Varicocele,  collinsonin,   169 

ergot,  182 
Varicose  veins,  ergot,  182 

hamamelis,  237 
Variola,    atropine,    72 
Veins,  relaxed,  hamamelin,  238 
Veratralbine,  354 
Veratrine,  354 

administration,  360 

antagonists,  361 

antidotes,  361 

dosage,  359 

physiologic  action,  355 

synergists,  360 
Veratroidine,  354,  358 
Veratrum  album,  358 
Verbena  hastata,  362 
Verbenin,  362 
Vesical  catarrh,  gelsemium,  227 

irritability,  barosmin,  78 
eupatorium,  224 
gossypin,  235 

paralysis,  ergot,  182 

tenesmus,   macrotin,   273 


Viburnin,  363 

Viburnum    prunifolium,   363 

Vital  -  incitation,  strychnine  arsenate, 

353 

Vomiting,  bilious,  boldine,  88 
capsicum,  133 
to  cause,  lobelia,  269 
creasote,  186 
cocaine,  159 
dioscorea,  208 
of  drunkards,  arsenic,  46 
iris,  256 

nervous,  cicutine,  147 
of  pregnancy,  atropine,  72 
cerium  oxalate,  137 
cocaine,    159 
eupatorium,  224 
iridin,  255 
menthol,   276 
pepsin,  209 
strychnine,  351 
Vulvitis,    echinacea,    211 

WARTS,  arsenic,  47 

Weakness,  nervous,  caffeine.  105 

Whooping-cough,  atropine,  65 

benzoic  acid,  81 

butyl  chloral  hydrate,  98 

calcium    iodized,    116 

camphor  monobromide,   118,   119 

caulophyllin,   136 

cerium  oxalate,  138 

cicutine,   147 

emetine,  216 

eupatorium,  225 

formalin,   119 

gold,  234 

helenin,  239 

hyoscyamine,  250 

lobelia,  270 

macrotin,  273 

narceine,  286 

pilocarpine,  310 

quinine,  325 

sanguinarine,   338 

strophanthus,  347 

zinc  oxide,  371 
Wild  yam,  208 
Wintergreen,  142 
Worms,  iodoform,  253 
koussein,  265 
podophyllin,  313 
round,  santonin,  339 
seat,  quassia,  320 
salicylic  acid,  336 
verbena,  362 

Wormseed,  German,  338 
Wounds,  benzoin,  81 


402 


INDEX. 


XANTHOXYLIN,  365 

specific  indications,  366 
Xanthoxylon,  86 
Xanthoxylum  fraxineum,  365 

YELLOW  FEVER,  cocaine,  159 
Yohimbine,  366 

ZINC  CYANIDE,  368 

physiologic  action,  369 


Zinc  cyanide,  therapeutic^,  370 
oxide,  371 
phosphide,  371 

dosage,  374 

therapeutics,  373 
sulphocarbolate,  375 

therapeutics,  376 
valerianate,   378 
Zoster,  iris,  255 
veratrine,  350 
zinc  phosphide,  ^4 


LIST  OF  AUTHORS  WHOSE  WRITINGS  HAVE 
BEEN   QUOTED   IN   THIS   WORK. 


ABADIE 
Abbott 

Adrian 
Albers 

Aran 
Arnaud 

Auldc,  John 
Ayer 

Abegg 

Albertoni 

BAKOFEN 

Bird 

Boldt 

Brunton 

Barbier 

Bezold 

Bolognesis 

Bryan 

Bardet 

Blackerby,  J.   M. 

Borchain 

Bryce,  C.  A. 

Bardsley 

Blake 

Bossi 

Buchanan,  R.  E. 

Bartholow 

Blesh.  A.  L. 

Botkin 

Buchheim 

Batelli 

Bloch 

Bourgoin 

Buchner. 

Bauduy 

Bloebaum 

Bourneville 

Bucholtz 

Beil 

Bloyer 

Bouchet 

Bunge 

Berger 

Blythe,  W.  H. 

Bowers 

Burggraeve 

Bernard,  Claude 

Bocquillon 

Brandao 

Burkart 

Bernheim 

Bocquillon-Limou-Brenekle.  J.  F. 

Burland 

Bietti 

sin 

Bright 

Burnett 

Billroth 

Boehm 

Brouardel 

Buzdygan 

Binz 

Boujean 

Brown-Sequard 

CALMETTE 

Chanteaud 

Clarke 

Cox,    Mason 

Campardon 

Charcot 

Clarus 

Croftan,   A.   C. 

Carsares 

Chauvin 

Clemens,  T. 

Culbertson 

Casaubon 

Cheron 

Combemale 

Curci 

Case,  Z.  C. 

Chetwood-Aiken 

Cornet 

Cushny 

Gate 

Chiappa 

Corry 

Cuzner,  A.  T. 

Cerna 

Clark 

Cownley 

Czerny 

DA  COSTA 

Demme 

Dietrich 

Dragendorff 

Darwin 

Deneffe 

D'Oliveiro 

Duquesnel 

Day,  W.  L. 

Denissenko 

Dornblueth 

Dujardin    Beau- 

Delache 

De  Rosa 

Doerrenberg 

metz 

Demant 

Desnos 

EBERTH 

Eguiguren 

Engel 

Erlenmeyer 

Ebstein 

Ellingwood 

Epstein 

Eulenberg 

Eckfeldt 

Eloy 

FAIR,  H.  D. 

Feris 

Fraenkel 

Friend,  F.  M. 

Falck 

Ferran 

Fraser 

Froehde 

Falconer 

Filehne 

French,  G.  H. 

Froehlich 

Falk 

Flaxen 

Fretz 

Fronmueller 

Farnum 

Fohner 

Friedenwald 

Frotheringham 

Fellner 

Fothergill 

Friedlaender 

Fuerbringer 

Felter 

GAERTIG 

Gies 

Goerz 

Gregory 

Gallard 

Ginley,  A.  H.  R. 

Gottlieb 

Gris 

Garrod 

Gluzinski 

Gottschalk 

Gubler 

Geiger 

Glinski 

Gratz 

Guyon 

Geppert 

APPENDIX 


APPENDIX 


The  following  is  a  further  elaboration  of  some  topics  already  dis- 
cussed, with  the  addition  of  such  material  omitted  or  under  investi- 
gation when  the  body  of  the  volume  was  closed. 

We  solicit  the  helpful  criticism  of  all  to  make  the  next  edition  of 
this  work  even  more  complete.  In  what  are  we  wrong?  What  will 
you  add  of  helpful  fact  ? 

ARSENIC  IODIDE. 

Standard  tablet — Gr.  1-67;  gm.  .001. 

The  iodide  of  arsenic  has  two  important  characteristics ;  both  ele- 
ments act  notably  upon  the  eyes,  and  the  irritation  denoting  full  ef- 
fect occurs  more  quickly  than  with  any  other  preparation  of  either 
arsenic  or  iodine ;  and  for  this  reason  the  remedial  effect  of  arsenic 
is  secured  more  promptly  than  with  any  other  preparation  of  this 
metal. 

Burggraeve  utilized  arsenic  iodide  principally  in  skin  diseases, 
especially  the  dry  forms  where  the  pores  of  the  skin  are  obstructed 
and  crusts  or  furfuracebus  scales  formed. 

Thirteen  years  ago  the  writer  was  consulted  by  a  lady  of  ad- 
vanced age  who  showed  evidences  of  arteriosclerosis  and  was  threat- 
ened with  senile  gangrene.  She  was  given  arsenic  iodide,  which  was 
continued  a  year.  The  pain  and  other  subjective  symptoms  subsid- 
ed, the  malady  was  apparently  checked  and  to  the  present  day  has 
not  made  any  progress,  the  senile  arc  then  manifest  being  unchanged. 
Since  that  time  this  has  been  the  writer's  favorite  remedy  in  this  af- 
fection, and  the  results  of  its  administration  have  been  satisfactory 
to  him  and  to  his  patients. 

In  treating  those  acute  manifestations  of  syphilis,  cerebral,  etc., 
that  are  commonly  met  with  maximal  doses  of  potassium  iodide,  ar- 
senic iodide  has  been  substituted,  with  mercury  biniodide  and  iodo- 
form,  from  the  belief  that  a  quicker  and  more  powerful  effect  is  thus 
secured,  and  in  this  belief  experience  justifies.  The  necessity  for  the 
quickest  possible  action  is  better  comprehended  if  the  physician  real- 
izes that  while  syphilis  may  be  checked  or  cured,  this  does  not  re- 
store life  to  dead  tissues  or  continuity  to  ruptured  nerve  fibers.  The 


2  APPENDIX 

superiority  of  the  combination  herein  recommended  over  potassium 
iodide  is  manifest  to  the  most  superficial  observer. 

The  dose  of  arsenic  iodide  is  gr.  1-67  three  or  four  times  a  day 
for  an  adult.  Few  persons  can  take  more  than  five  daily  doses  of 
this  size  without  irritation  of  the  eyes  quickly  following1.  The  lady 
whose  case  is  mentioned  was  thus  affected  by  five  granules  a  day ; 
but  took  four  a  day  for  a  year,  with  only  benefit. 

The  iodides  are  exceedingly  valuable  preparations  and  it  should 
be  our  study  to  find  and  our  practice  there  to  exhibit  those  which 
produce  greatest  and  most  satisfactory  results  with  the  least  imita- 
tion. There  will  be  found  in  the  newer  preparations,  arsenic  iodide 
and  calcium  iodized.  Do  not  confound  this  latter  with  calcium  iodide, 
a  very  inferior  product,  one  really  weak  in  iodine,  as  compared  to 
this  supersaturated  lime  product,  "Calcium  Iodized,"  or  "Calcidin," 
as  it  is  called. 

ARSENIC  SULPHIDE. 

Standard  granule — Gr.  1-67;  gm.  .001. 

Orpiment,  the  yellow  or  trisulphide  of  arsenic,  is  not  utilized  in 
the  materia  medicas,  but  has  won  a  place  in  the  arsenal  of  alkalom- 
etry.  We  have  employed  it  with  great  satisfaction  for  the  ordinary 
cases  in  which  arsenic  is  given ;  as  an  alterative  in  skin  affections, 
etc.,  etc. ;  its  specific  place,  however,  is  as  a  remedy  for  gonorrhea' 
especially  for  the  so-called  rheumatism,  or  septicemia.  For  this  the 
writer  introduced  the  treatment  by  calcium  sulphide,  gr.  i,  and  ar- 
senic sulphide,  gr.  1-67,  four  times  a  day,  gradually  rising  to  seven 
doses  daily  until  the  odor  of  rotten  eggs  on  the  breath,  and  perspira- 
tion, showed  that  the  body  was  saturated  with  the  sulphides.  This 
effect  is  to  be  sustained  for  two  weeks,  or  until  the  disease  has  dis- 
appeared, and  it  always  does  disappear. 

Does  the  arsenic  sulphide  here  add  anything  to  the  effect  of  cal- 
cium sulphide?  In  several  cases,  when  the  calcium  sulphide  alone 
did  not  appear  as  effective  as  was  expected,  the  addition  of  arsenic 
sulphide  was  followed  by  immediate  improvement. 

Would  arsenic  sulphide  alone  do  the  work  now  accomplished  by 
calcium  sulphide?  If  so,  the  benefits  are  obvious,  the  smaller  doses, 
ease  of  manipulation,  permanency  of  product,  etc.  This  question  has 
yet  to  be  answered ;  for,  having  been  so  successful  with  the  combined 
treatment  we  haven't  had  the  heart  to  try. 

This  remedy  gives  remarkable  results  in  acne  and  many  forms  of 
skin  disease.  Gr.  1-67  after  meals,  with  three  to  four  of  the  Sulphur 


APPENDIX  3 

Comp.  granules  (formula  credited  to  Dr.  Buckley:  Pulverized  sul- 
phur, gr.  1-134;  extract  nux  vomica,  gr.  1-67;  podophyllin,  neutral, 
gr.  1-67;  collinsonin,  gr.  1-134),  will  soon  cause  marked  ameliora- 
tion, especially  if  eliminative  and  antiautotoxic  measures  are  taken 
at  the  same  time.  In  ichthyosis  this  drug  gives  prompt  results. 
Ichthyol  and  resorcin  should  be  used  externally  after  magnesium- 
sulphate  solution  baths.  • 

In  albuminuria  arsenic  sulphide  will  be  found  of  signal  service. 
Dosage  should  be  increased  to  tolerance.  In  so-called  "bronchial 
asthma"  this  remedy  will  prove  efficacious  if  given  in  alternation 
with  an  acid.  The  cases  most  benefited  are  those  in  which  there  is 
profuse  expectoration. 

Eczema  will  respond  to  arsenic  sulphide  and  saline  elimination 
with  regulation  of  diet,  provided  it  be  of  the  dry  and  scaly  variety, 
and  if  at  the  same  time  hepatic  and  renal  action  is  kept  at  par  by  the 
use  of  calomel  and  iridin,  with  subsequent  saline  draughts  as  sug- 
gested above :  One  granule  after  meals. 

In  prurigo,  pruritus  and  psoriasis,  mercury  biniodide  and  arsenic 
sulphide  may  be  given  alternately  with  good  results. 

Arsenic  sulphide  is  one  of  our  best  cellular  alteratives  where  sur- 
face tissues  and  other  excretory  structures  are  involved.  It  must  be 
known  to  be  appreciated  and  must  be  used  right  and  associated  right 
to  produce  the  results  outlined.  It  can  be  done. 

CALCIUM  SULPHIDE. 

Standard  granules— Gr.  1-6,  0.01;  gr.  1-2,  0.03. 

When  Ringer's  Therapeutics  first  appeared,  the  medical  profes- 
sion was  startled  to  find  very  small  doses  recommended,  which 
caused  the  epithet  of  "homeopathist"  to  be  hurled  against  the  author. 
At  that  time  even  the  slight  innovation  of  dividing  the  ordinary  daily 
dose  into  ten  or  twenty  portions  instead  of  three  was  sufficient  to 
arouse  doubt  as  to  an  author's  orthodoxy.  One  of  the  most  suspic- 
ious articles  he  recommended  was  calcium  sulphide,  in  doses  of  gr. 
i- 10  every  hour.  In  the  form  of  potassium  sulphuret  the  former 
Dispensatories  contained  long  articles  advocating  the  use  of  sul- 
phurous acid,  but  not  a  word  on  calcium  sulphide.  Little  impres- 
sion, however,  'was  made  upon  the  practice  of  the  profession;  the 
drug  was  neglected,  and  consigned  to  the  boneyafd  of  discarded 
remedies,  retaining  a  place  in  attenuated  form  with  the  homeopa- 


4  APPENDIX 

thists  under  the  name  of  "hepar  sttlph." — a  sort  of  "in  memoriam," 
as  it  were,  but  one  which  has  been  of  real  value,  as  you  shall  see. 

Ringer's  reintroduction  of  the  drug  was  followed  by  some  desul- 
tory trials,  but  its  use  gradually  died  out,  with  the  single  exception 
of  its  employment  as  an  abortive  of  boils,  for  which  some  insisted 
strongly  that  it  was  good  while  others,  equally  as  able  observers, 
strenuously  avowed  it  to  be  good  for  nothing.  It  has  since  been 
closely  demonstrated  that  their  failure  was  due  to  the  difficulty  of 
obtaining  the  salt  in  a  fit  condition  for  administration,  and  the  very 
small  doses  given;  not  taking  into  consideration  the  fact  that  this 
preparation  is  variable  (always  weaker  rather  than  stronger)  and 
that  variable  preparations  of  this  class,  more  than  all  others  of  which 
it  is  likewise  true,  must  be  pushed  (increased  as  to  amount  given 
each  time  as  well  as  to  frequency  of  administration)  until  effect — 
to  dose  enough ! 

The  sulphide  of  the  shop  consists  of  a  mixture,  in  varying  pro- 
portions, of  calcium  sulphide,  calcium  hyposulphate  and  the  true 
calcium  monosulphide,  the  latter  constantly  decreasing  in  relative 
proportion  as  it  decomposes  in  the  presence  of  the  bottle-contained 
air.  So  that,  as  in  many  other  instances  and  from  the  same  or  a 
similar  cause,  the  modicum  used  on  the  doctor's  prescription  is  prac- 
tically inert.  The  same  is  also  true  of  compressed  tablets  and  par- 
ticularly so  of  tablet  triturates.  According  to  Shaller,  it  is  an  unusu- 
ally good  specimen  that  contains  30  per  cent  of  the  sulphide,  from 
that  to  nothing,  usually  practically  nothing,  being  the  points  between 
which  different  preparations  vary. 

During  the  preparation  of  this  study  I  have  bought  in  the  open 
market  and  had  carefully  tested  many  samples  of  calcium  sulphide, 
with  results  as  follows : 

The  highest  test  from  bottles  of  the  powder  in  drug  stores  was 
9  per  cent ;  G.  C.  pills  from  so-called  standard  manufacturers,  high- 
est, 13  per  cent;  tablets,  compressed  (one  firm  only)  60  per  cent; 
tablet  triturates,  30  per  cent ;  other  tablets  listed  36  to  40  per  cent ; 
alkaloidal  granules  65  per  cent. 

Calcium  sulphide  begins  to  decompose  the  moment  it  leaves  the 
utensils  of  manufacture,  the  rapidity  depending  upon  the  amount  of 
nonsaturated  air  with  which  it  comes  in  contact. 

The  oxygen  in  a  well-filled,  tightly-corked  bottle  of  calcium  sul- 
phide powder  once  good,  or  of  ordinary  tablets  never  really  good, 
from  the  time  the  process  of  manufacture  is  begun  and  always 
(especially  when  uncoated)  growing  poorer,  is  sufficient  to  render 


APPENDIX  5 

the  top  layer  inert,  and  occasional  opening  to  use  will  do  the  rest. 
Only  when  the  strictly  fresh  sulphide  is  rightly  made  into  a  proper- 
ly-protected but  readily-disintegrating  pill  or  granule  can  the  full 
strength  of  this  valuable  agent  be  retained,  and  without  this  it  is 
worthless.  Hence,  the  varying  opinions  as  to  the  therapeutic  value 
of  this  preparation.  So  difficult  is  this  pharmacal  problem  that  some 
honest  manufacturers  have  stricken  this  article  from  their  lists,  while 
from  most  of  the  remaining  pill  and  tablet  preparations  on  the 
shelves  in  the  shops  scarcely  a  trace  of  the  distinctive  odor  is  to  be 
detected  when  the  granules  are  broken  open.  A  bottle  containing 
calcium  sulphide  granules  or  tablets  that  are  right  emits  no  (or  but 
slight)  odor  on  opening,  but  a  taste  of  the  crushed  goods  at  once 
reveals  what  they  are.  The  stronger  the  characteristic  taste  the  bet- 
ter and  more  reliable  the  preparation.  The  odor  is  not  an  indication 
of  activity,  some  tablets  smelling  strongly,  showing  on  analysis  a 
low  percentage  of  sulphide.  Probably  the  odor  is  due  principally  to 
free  sulphydric  acid. 

Calcium  sulphide  is  prepared  by  passing  a  current  of  sulphureted 
hydrogen  over  lime,  by  the  action  of  carbonate  of  iron  or  carbon 
oxide  on  calcium  sulphate,  or  by  decomposing  lime  with  sulphide  of 
carbon  (Van  Renterghem).  It  is  a  grayish  white,  amorphous  powder 
with  a  disagreeable  but  characteristic  odor.  It  is  alkaline.  Exposed 
to  the  light  it  possesses  the  property  of  remaining  luminous  in  the 
darkness;  which  has  given  it  the  name  of  "Canton  phosphorus." 
This  quality  has  been  utilized  in  the  manufacture  of  match-boxes, 
which  are  covered  with  a  paint  containing  the  substance.  Boiling 
water  decomposes  calcium  sulphide  into  calcium  hydrate  and  sulphy- 
drate.  In  cold  water  the  carbonic  acid  sets  free  the  sulphureted 
hydrogen,  leaving  calcium  carbonate.  The  weakest  mineral  acids 
likewise  decompose  it. 

If  taken  into  the  stomach  during  the  period  of  acid  digestion,  the 
sulphide  is  decomposed  to  a  greater  or  less  extent,  setting  free  the 
sulphureted  hydrogen,  part  of  which  may  be  ejected  in  eructations  in 
which  the  gas  is  easily  recognized;  of  the  residue,  the  resultant 
sulphurous  acid  is  absorbed  as  well  as  the  undecomposed  portion; 
both  are  good,  for  both  are  active,  but  the  undecomposed  product  is 
most  desirable.  Absorbed,  it  is  broken  up  by  the  body,  the  surplus 
appearing  as  sulphydric  acid  eliminated  by  the  lungs  and  skin,  while 
the  urine  contains  an  excess  of  sulphates.  It  will  thus  be  seen  that 
the  best  results  are  obtained  from  the  exhibition  of  calcium  sulphide 
when  the  stomach  contents  is  alkaline  or  after  it  has  been  made  alka- 


6  APPENDIX 

line,  in  which  case  its  activity  practically  all  passes  into  the  blood 
and  other  circulating  fluids  to  permeate,  disinfect  and  clean  up  the 
workshop  of  every  living  cell — a  veritable  systemic  antiseptic,  a  reg- 
ular house-cleaner  of  the  most  desirable  character. 

In  1824  Woehler  demonstrated  that  the  sulphides  are  oxygen- 
ated in  the  body,  but  if  the  dose  ingested  is  very  large,  part  passes 
into  the  urine  in  the  form  of  sulphide,  which  blackens  the  salts  of 
lead.  After  toxic  doses  of  metallic  sulphides,  Woehler  and  Orfila 
showed  the  presence  in  the  urine  of  part  of  the  salt  as  unmodified 
sulphide,  beside  a  quantity  of  sulphates.  Considerable  quantities  of 
the  gas  may  be  disengaged  in  the  stomach  without  causing  any 
deleterious  action  on  the  red  blood  cells ;  but  if  taken  in  through  the 
lungs,  sulphureted  hydrogen  unites  with  the  hemoglobin,  reducing 
it  to  methemoglobin ;  and  this  union  once  formed  it  is  exceedingly 
difficult  to  break. 

Respired  in  quantity  it  has  caused  death  from  rapidly-induced 
asphyxia;  this  has  led  to  timidity  in  the  use  of  the  sulphides,  pre- 
venting the  demonstration  of  their  therapeutic  possibilities.  But  in 
gonorrhea  calcium  sulphide  of  the  best  quality  has  been  given  with 
impunity  in  doses  ascending  to  fifty  grains  in  24  hours,  and  with 
marvelous  curative  effect,  while  children  with  diphtheria  have  taken 
two  grains  every  two  hours  for  days,  with  benefit  and  no  harm.  It 
has  been  injected  intravenously  with  impunity.  Here  the  acid 
reaches  the  lungs  after  passing  the  right  heart,  and  is  eliminated  into 
the  atmosphere  with  the  carbonic  acid,  the  left  heart  receiving  very 
little.  But  this,  carried  through  the  circulation,  slightly  stimulates 
the  sweat  glands  (Rabuteau)  : 

During  its  elimination  by  these  various  routes,  the  sulphide  of 
calcium  exerts  an  action  on  the  respiratory  mucosa,  whose  secretion 
is  stimulated  and  expectoration  loosened ;  on  the  sweat  glands,  whose 
excretion  is  likewise  augmented;  on  the  kidneys,  producing  diuresis 
by  the  sulphydric  acid  and  the  sulphates ;  and  in  general  an  increased 
activity  of  the  circulation,  possibly  some  fever  and  an  increase  of  the 
appetite  (Rabuteau). 

Shaller  says  that  the  toxins  produced  by  the  bacteria  of  various 
zymotic  diseases  are  neutralized  by  the  presence  of  sulphureted  hy- 
drogen in  the  blood ;  or  the  white  blood  corpuscles  are  stimulated  to 
unusual  vigor  and  their  phagocytic  powers  greatly  increased.  But 
it  has  seemed  to  the  writer  that  the  phenomena  following  saturation 
by  the  sulphides  is  better  explained  by  the  hypothesis  that  this  ren- 
ders the  continued  life  and  activity  of  these  organisms  in  the  satu- 


THERAPEUTIC   NOTES 


THERAPEUTIC  NOTES 


APPENDIX  7 

rated  body  impossible — either  killing  or  inhibiting  them.  Whether 
this  action  is  exerted  on  some  microorganisms  only,  or  upon  all 
forms,  is  uncertain.  The  cessation  of  suppuration  coinciding  with 
saturation,  indicates  that  all  ordinary  pyogenic  bacteria  are  proba- 
bly destroyed  by  the  sulphides.  In  any  event  its  control  action  over 
scarlatina,  measles,  smallpox,  whooping-cough,  etc.,  is  beyond  ques- 
tion. 

The  remarkable  power  exerted  over  diphtheria  by  calcium  sul- 
phide is  a  discovery  which  the  world  owes  to  Fontaine,  of  Bar-sur- 
Seine,  whose  first  paper  appeared  in  1875.  Increasing  the  bronchial 
and  cutaneous  excretions,  it  aids  in  eliminating  the  toxin.  But  the 
principal  effect  for  which  it  is  given  is  that  of  a  parasiticide,  as  which 
it  has  no  equal  when  applied  locally.  Fontaine  preferred  the  lime 
salt  to  that  of  potassium  or  soda,  because  the  former  also  supplied 
an  element  needed  for  repairing  the  damage  inflicted  by  the  disease. 

The  earlier  reports  were  favorable,  but  in  desperate  or  malignant 
cases  the  remedy  failed,  as  it  was  still  given  timidly  in  insufficient 
doses.  But  this  fear  was  subsiding ;  and  we  find  Ringer  prescribing 
calcium  sulphide  in  doses  from  gr.  1-6  up  to  forty  times  this  quan- 
tity, many  times  a  day,  in  anthrax,  furunculosis,  scrofulous  ulcers, 
and  for  purulent,  ichorous  and  sanious  wounds.  Fock  also  found  it 
useful  in  acute  mammary  abscesses. 

Chaussier  had  employed  potassium  sulphide  for  croup  and  diph- 
theria as  early  as  1808,  and  Ribes  in  1818;  but  they  had  dropped  it 
on  account  of  the  difficulty  in  administering  it  in  potions  to  children ; 
and  it  was  not  till  modern  pharmacy  had  evolved  the  granule  that 
the  remedy  was  made  available. 

While  in  diphtheria  calcium  sulphide  is  given  as  the  dominant 
or  leading  remedy,  the  variants  or  adjuvants  are  by  no  means  unim- 
portant. Fever  demands  aconitine,  digitalin ;  periodicity  calls  for 
quinine  arsenate  or  hydrof errocyanate ;  emetics  may  promote  the 
loosening  of  false  membranes;  strychnine  restores  the  normal  tone 
(Van  Renterghem)  ;  and  antitoxin  should  not  be  forgotten,  though 
rarely  needed. 

Fontaine  also  urged  the  sulphide  for  whooping-cough,  in  which 
he  has  been  followed  by  many.  Droixhe  at  first  gave  the  sulphide 
only  in  the  second  period,  but  later  he  gave  it  from  the  first,  and 
esteemed  it  equal  in  efficacy  in  this  malady  as  in  diphtheria.  Shaller 
has  given  it  continuously  for  three  or  four  .weeks,  always  with 
marked  reduction  in  the  number  and  frequency  of  the  paroxysms, 
without  anemia  resulting. 


8  APPENDIX 

Coleman  has  obtained  equal  success,  and  claims  that  even  in  the 
incubation  this  disease  may  be  aborted  by  saturation  with  calcium 
sulphide  and  the  conjoint  use  of  atropine  to  full  effect.  Since  it  is 
now  admitted  that  this  disease  is  due  to  microorganisms,  and  that 
during  this  period  they  are  actively  at  work,  it  seems  perfectly  rea- 
sonable to  suppose  that  they  may  be  effectively  combated  then,  when 
their  numbers  are  small.  Coleman  has  taken  children  who  were  not 
immune,  saturated  them  with  these  remedies,  and  exposed  them  to 
this  most  infectious  of  all  ailments ;  when  they  not  only  did  not  con- 
tract it  then  but  when  exposed  during  subsequent  epidemics  proved 
to  be  immune,  and  with  all  of  this  from  our  experience  we  most 
heartily  concur. 

The  results  obtained  in  these  two  affections  encouraged  trial  of 
the  sulphide  in  other  infections.  Castro  tried  it  in  smallpox.  His 
rules  are: 

i.  Begin  treatment  as  soon  as  the  malady  is  suspected.  2.  Sat- 
urate the  organism  with  the  parasiticide.  3.  Keep  up  the  saturation 
until  certain  of  the  effect.  4.  Even  if  the  eruption  has  appeared  it 
may  be  made  to  retrograde  so  that  vesiculation  does  not  occur.  5. 
Pustulation  under  way,  the  sulphide  may  still  prevent  complications, 
destroy  the  odor,  abate  considerably  the  fever,  and  attenuate  the 
gravity  of  the  attack  in  hastening  desiccation.  6.  The  disagreeable 
odor  of  the  sulphide  and  the  necessity  of  giving  it  in  numerous  small 
doses  renders  the  use  of  granules  advisable,  which  must  be  known 
to  be  active  if  a  correct  judgment  as  to  its  value  is  to  be  made.  7. 
The  intensity  of  the  administration  should  be  commensurate  with 
the  effects  required  by  the  nature  of  the  case. 

Castro  also  applied  this  remedy  in  this  manner  in  treating  roseola 
and  erysipelas. 

Van  Renterghem  employed  the  sulphide  in  four  cases  of  scarlet 
fever,  two  anginous,  saving  all,  and  that  in  a  very  short  time  and 
with  a  brief  convalescence. 

Shaller  says  that  measles,  whooping-cough,  scarlet  fever,  small- 
pox, diphtheria  and  erysipelas  are  all  more  easily  controlled  and 
freer  from  sequels  when  this  remedy  is  used.  He  gives  it  through- 
out the  course,  adding  aconitine  for  fever,  caffeine  for  threatened 
collapse  or  heart  failure,  strychnine  for  paralysis.  If  the  throat  is 
inflamed  he  gives  the  sulphide  in  solution,  in  severe  cases  every  fif- 
teen minutes,  so  that  the  solution  almost  constantly  bathes  the  in- 
fected surface. 

Many  physicians  have  employed  calcium  sulphide  in  smallpox 


APPENDIX  9 

during  the  last  epidemic  in  the  west,  and  generally  with  good  re- 
sults. Given  early  to  saturation,  most  cases  seem  to  be  abortive  and 
the  secondary  suppuration  and  its  fever  are  wanting.  It  is  also  a 
markedly  reliable  preventive  or  modifier  in  exposed  cases  but  must 
be  given  early  and  in  large  doses. 

In  respiratory  affections  Van  Renterghem  recommended  calcium 
sulphide  as  an  expectorant,  in  the  dry  coughs  of  commencing 
catarrhs ;  in  phthisis ;  to  increase  secretion  and  facilitate  expectora- 
tion. Shaller  praises  it  for  tough,  scanty  sputa  in  measles  and  per- 
tussis with  distressing  cough,  in  chronic  lung  diseases  where  the 
sputa  is  putrid.  Aulde  advised  this  remedy  to  abort  a  commencing 
coryza.  It  has  been  suggested  that  if  other  microorganisms  can  not 
live  in  the  human  body  when  saturated  with  it,  why  should  the 
tubercle  bacillus?  The  question  has  not  been  settled,  but  is  well 
worth  consideration. 

In  acute  gonorrhea  there  is  no  remedy,  not  even  copaiba,  which 
will  so  surely  and  so  promptly  stop  the  discharge ;  and  unlike  the 
time-honored  but  useless  balsam,  and  to  the  great  relief  of  the  pa- 
tient, the  discharge  does  not  return  the  moment  the  remedy  is  dis- 
continued. The  doses  must  be  large  but  a  permanent  cure  may  be 
usually  achieved.  One  physician  reports  unvarying  success  from 
doses  up  to  fifty  grains  each  24  hours.  It  is  the  most  reliable  rem- 
edy in  chronic  gonorrhea.  The  writer  has  never  known  any  remedy 
to  be  of  benefit  in  gonorrheal  "rheumatism,"  except  the  sulphides  of 
calcium  and  arsenic ;  and  these  have  not  as  yet  failed  to  cure  every 
case  of  this  malady  brought  to  his  notice. 

In  various  skin  diseases  calcium  sulphide  has  been  used  locally, 
forming  an  ingredient  of  the  famous  solution  of  Vleminckx.  In 
Alaska  it  has  been  found  that  the  voracious  mosquitoes  will  not  at- 
tack a  man  whose  skin  is  covered  with  a  solution  of  this  remedy. 

This  brings  us  to  the  question  of  the  use  of  calcium  sulphide  as 
a  prophylactic  in  malaria  and  in  yellow  fever — both  transmitted  to 
man  through  the  bites  of  mosquitoes.  In  the  experiments  made  in 
Cuba  it  was  found  that  the  insects  would  not  bite  some  persons  at 
all,  and  that  others  at  times  were  not  attacked.  The  reason  was  not 
ascertained.  Persons  who  drink  artesian  water,  which  is  often 
charged  with  sulphides,  are  not  affected  by  malaria.  It  seems  -worth 
trial,  to  see  if  mosquitoes 'will  attack  men  who  are  saturated  with 
this  agent  so  that  their  skins  exhale  it ;  as  i.f  so,  the  problem  of  im- 
munity to  those  whose  duty  requires  their  exposure  at  night  may  be 
simplified. 


10  APPENDIX 

Van  Renterghem  advises  that  calcium  sulphide  be  given,  even  to 
infants  of  the  most  tender  age,  in  granules  containing  gr.  1-6  every 
quarter  hour  in  acute  cases ;  to  adults  two  or  more  granules ;  until 
saturation  is  denoted  by  the  odor  of  the  drug  appearing  on  the 
breath  or  the  skin.  The  eructation  of  sulphureted  hydrogen  is  less 
certain  as  the  acid  gastric  juice  will  decompose  the  salt  and  disen- 
gage the  gas  even  when  a  single  dose  has  been  given.  If  the  drug 
is  pushed  too  rapidly  it  may  cause  nausea  and  this  has  been  taken  to 
indicate  saturation ;  but  is  rather  an  indication  for  smaller  doses. 

After  saturation  has  been  secured  the  doses  need  not  be  given  so 
frequently,  but  just  enough  to  keep  up  this  effect  as  long  as  it  is 
deemed  requisite.  In  infectious  diseases  it  is  well  to  sustain  satura- 
tion for  one  week ;  in  tuberculosis  for  two  or  more  weeks ;  in  gen- 
eral, till  the  danger  has  ceased. 

How  much  is  required  to  produce  saturation?  It  varies.  Fon- 
taine gave  20  granules  to  a  child  a  year  old,  30  to  one  of  22  months, 
60  to  adults,  within  24  hours.  Castro  gave  60  to  90  granules  to 
adults  in  the  same  time.  As  a  prophylactic  five  granules  may  be 
given  daily  to  infants,  ten  to  adults — just  "dose  enough"  is  right. 
Fontaine  says  that  when  calcium  sulphide  was  administered  to  all 
the  children  as  a  prophylactic,  during  an  epidemic  of  diphtheria,  he 
was  frequently  called  to  see  adults  ill  with  that  malady  when  the 
children  in  the  house,  taking  the  sulphide,  were  immune.  The  epi- 
demic really  ceased  only  when  the  use  of  this  prophylactic  had  be- 
come general. 

Externally,  solutions  of  one  part  to  ten  of  water  may  be  applied ; 
the  skin  to  be  washed  soon  to  avoid  undue  irritation. 

The  solutions  for  use  must  be  freshly  prepared  each  day,  as  they 
quickly  decompose.  Glass  spoons  should  be  used  for  dispensing, 
as  silver  is  blackened  by  it.  Shaller  says  that  persons  who  swallow 
the  granules  do  not  tire  of  the  medicine  as  soon  as  those  who  take 
it  in  solution;  that  is  also  our  experience.  If  the  eructations  are  dis- 
agreeable the  remedy  should  not  be  taken  just  after  meals. 

In  some  cases  where  there  is  intense  acidity  calcium  sulphide 
will  not  be  tolerated  by  the  patient,  as  each  dose  will  cause  nausea 
or  even  vomiting.  This  annoying  condition  can  be  promptly  con- 
trolled by  exhibiting  two  grains  of  vegetable  charcoal  ten  or  fifteen 
minutes  before  the  calcium  sulphide.  The  writer  has  found  that  re- 
sults are  more  speedy  and  pronouncd  when  these  remedies  are  given 
together  in  this  manner. 

Experience  has  amply  proven  that  the  small  dose  at  frequent  in- 


APPENDIX  H 

tervals  is  the  most  effective.  The  ordinary  compressed  tablets  con- 
taining one-half  and  one  grain  and  coated  or  uncoated  are  practi- 
cally useless ;  they  pass  from  the  stomach  into  the  intestine,  where 
no  chemical  change  takes  place.  To.  bring  a  patient  promptly  under 
the  effect  of  this  drug  two  or  four  granules,  gr.  1-6,  should  be 
given  hourly  or  half-hourly  and  one  granule  (gr.  1-6)  will  usually 
prove  quite  as  efficient.  The  secret  oFsuccess  is  to  saturate  the  sys- 
tem quickly  and  then  to  maintain  this  condition  with  smaller  doses 
given  at  longer  intervals.  The  calcium  sulphide  patient  usually  calls 
for  eliminatives  and  the  tonic  arsenates. 

It  will,  therefore,  he  seen  that  to  have  a  good  preparation  is  most 
essential  and  that  even  this  may  be  given  wrongly.  A  good  prepara- 
tion chemically  broken  up  in  the  stomach  and  given  to  "dose  enough" 
will  produce  results  most  desirable  and  satisfactory. 

COPPER  ARSENITE. 

• 

Standard   granules   and   tablets— Gr.  i-iooo;  1-250;  i-ioo—gm.  .0000625; 
00025, .000625. 

Copper  arsenite  is  a  valuable  intestinal  disinfectant.  It  is  toxic 
in  overdoses,  causing  heat  and  irritation  as  with  other  forms  of 
arsenic,  but  especially  manifest  in  the  duodenum,  where  it  exercises 
its  special  activity,  and  the  small  intestines  generally,  since  the 
drug  is  here  principally  eliminated.  It  is  then  reabsorbcd  by  the 
glandular  apparatus,  whose  cells  will  be  irritated  if  the  dose  be  too 
large.  Medicinal  doses  stimulate  these  cells  and  restore  their  func- 
tional activity.  By  this  means  the  absorption  of  toxic  materials 
is  hindered  and  normal  elimination  favored. 

The  role  of  copper  arsenite  therefore  differs  radically  from  that 
of  the  ordinary  intestinal  antiseptics,  in  that  the  former  does  not 
act  as  a  chemical  disinfectant,  nor  as  a  germicide,  but  is  rather  a 
stimulant  of  the  functions  of  the  gland  cells  of  the  gastrointestinal 
mucous  membrane.  Its  place  is  therefore  after  the  alimentary 
canal  has  been  cleared  by  calomel  and  saline,  and  the  fetidity  of 
the  stools  removed  by  the  sulphocarbolates.  The  restoration  of  the 
secretory  function  is  then  indicated,  and  completes  the  cure.  For 
this  purpose  copper  arsenite  has  approved  itself  as  remarkably  effec- 
tive. It  is  recommended  in  a  very  wide  range  of  diseases,  even  as 
an  antiseptic  in  typhoid  fever,  cholera  infantum,  etc. 

When  there  is  fermentation  in  the  stomach  or  duodenum,  clear 
the  bowels  and  copper  arsenite  will  put  an  end  to  the  nausea,  pain 


12  APPENDIX 

and  diarrhea  very  quickly.  When  there  is  pain  immediately  after 
eating",  indicating  stomach  indigestion,  or  several  hours  after  meals, 
indicating  intestinal  indigestion,  copper  arsenite  taken  before  each 
meal  will  give  prompt  relief. 

Shaller  describes  his  first  case  treated  by  this  remedy — a  child 
with  cholera  infantum,  profuse  diarrhea,  constant  vomiting,  ema- 
ciated, almost  in  collapse.  Improvement  was  manifest  within  two 
hours,  and  recovery  ensued.  The  Doctor's  experience  was  so  typic 
of  what  occurs  when  an  old  and  successful  physician  first  lays  aside 
his  tried  methods  to  experiment  with  a  new  one  that  promises  bet- 
ter things,  that  we  will  quote  it  here  verbatim : 

"It  must  be  confessed  that  the  writer  felt  extremely  uneasy  in 
leaving  this  patient  in  such  a  dangerous  condition  and  prescribing 
only  1-500  of  a  grain  of  copper  arsenite.  It  seemed  as  if  this  small 
dose  could  not  possibly  bring  relief  in  so  serious  a  condition.  After 
passing  two  very  uneasy  hours,  the  patient  was  again  visited,  think- 
ing possibly  that  the  child  was  dead,  and  if  so  it  died  simply  be- 
cause active,  substantial  treatment  had  not  been  given.  After  treat- 
ing many  cases  in  Cincinnati  at  that  period,  when  cholera  infan- 
tum was  extremely  common,  by  well-established  methods,  by  giving 
tangible  doses,  it  seemed  almost  like  murder  to  turn  around  and 
give  only  1-500  of  a  grain  of  copper  arsenite. 

"Considerable  relief  was  experienced  when  the  patient  was 
found  alive;  utter  amazement  was  expressed  when  it  was  learned 
that  by  giving  so  small  a  dose  actual  improvement  had  occurred. 
Vomiting  and  stools  were  less  frequent,  and  some  general  improve- 
ment was  manifested  which  continued  and  the  child  made  a  com- 
plete recovery. 

"Probably  all  physicians  feel  just  this  way  when  changing  from 
old  ways  with  single  large  doses  to  the  newer  way;  to  this  only 
way;  to  what  appears  to  be  extremely  minute,  almost  infinitesimal 
and  inadequate  doses.  Yet  it  is  a  fact  easily  verified  that  apparently 
minute  doses,  frequently  repeated  to  effect,  cure.  Everything  in 
dosimetric  medicine  tends  to  prove  this.  Strong  prejudices  in  favor 
of  large  doses,  and  old  favorable  methods,  deeply  rooted,  must  all 
give  way  to  the  certain  and  prompt  response  following  small  doses 
frequently  repeated." 

Arsenic  in  very  small  doses  has  been  recommended  as  a  gastric 
sedative  in  many  conditions,  such  as  the  vomiting  of  pregnancy  and 
the  morning  sickness  of  drunkards.  There  is  no  other  arsenical 


THERAPEUTIC   NOTES 


THERAPEUTIC  NOTES 


APPENDIX  13 

preparation  quite  so  effective  as  the  copper  salt  in  such  cases.  The 
small  dose  and  lack  of  unpleasant  taste  gives  it  a  great  advantage. 

The  average  dose  of  copper  arsenite  is  from  gr.  1-250  to  i-ioo. 
This  may  be  given  every  half.-hour  in  acute  gastric  irritations,  or 
before  meals  in  chronic  cases.  Irritation  or  pain  following  it  indi- 
cates smaller  doses,  and  benefit  will  often  follow  doses  of  gr.  i-iooo, 
frequently  repeated.  To  infants  the  latter  dose  may  be  given  every 
half-hour  or  less  frequently.  Shaller  strongly  advises  that  this  rem- 
edy be  given  in  solution. 

The  only  indication  of  action  usually  is  the  subsidence  of  the 
pain,  nausea  and  diarrhea,  and  the  improved  condition  of  the  stools. 
Irritation  of  the  stomach  indicates  toxic  action,  but  it  does  not  imply 
that  the  remedy  has  been  ill-chosen,  but,  rather,  that  the  doses  have 
been  too  large.  Keeping  just  below  the  irritative  point  usually 
gives  the  most  decisive  therapeutic  effect — the  small  dose  fre- 
quently repeated  until  the  desired  result  is  produced.  In  many 
cases  it  is  a  decided  advantage  to  give  a  glass  of  hot  water  with  a 
scruple  of  baking  soda  an  hour  before  food  is  taken,  and  the  copper 
arsenite  half  an  hour  later,  when  the  remedy  may  obtain  access  to 
the  cleaned  surface  of  the  diseased  mucous  membrane,  and  be  out 
of  the  way  by  the  time  food  is  to  be  introduced.  Most  of  the  ar- 
senic given  is  wasted  by  neglect  to  administer  it  scientifically :  If  taken 
after  meals  it  is  mostly  converted  into  iron  arsenate,  which  is  almost 
insoluble  and  is  discharged  in  the  stools.  Bartholow  pointed 
out  that  persons  who  could  take  twenty  drops  or  more  of  Fowler's 
solution  after  meals  could  not  take  more  than  a  drop  or  two  before 
meals. 

Aulde  advocated  copper  arsenite  as  a  remedy  for  seasickness,  in 
doses  of  gr.  i-ioo  before  meals.  The  writer  has  found  this  sugges- 
tion of  value,  especially  .when  the  bowels  have  been  thoroughly 
cleared  and  the  diet  regulated,  adding  hyoscyamine  or  atropine  to 
slight  but  sustained  effect.  It  has  been  suggested  that  dilute  hydro- 
chloric acid  be  added  to  the  water  used  in  dissolving  copper  arsenite, 
for  local  or  hypodermic;  the  result  is  a  chlorarsenite  of  copper  solu- 
tion, which  is  stable.  One  grain  of  copper  arsenite  in  four  ounces 
of  water,  to  which  the  acid  is  added  drop  by  drop  until  a  clear  solu- 
tion results,  will  give  a  solution  of  -which  thirty  minims  will  equal 
gr.  1-65.  This  amount  is  recommended — hypodermically  exhibited 
— in  typhoid  and  tuberculosis  every  second  day.  Abscesses  do  not 
follow.  In  aphthae  and  stomatitis  a  solution  of  copper  arsenite  may 


14  APPENDIX 

be  used  locally,  and  a  spray  of  the  above  strength  is  said  to  be  ef- 
fective in  the  asthma  which  accompanies  hay  fever. 

In  some  bilious  attacks  gr.  i-iooo  in  hot  solution  will,  if  taken  at 
one-fourth  to  half-hourly  intervals,  prove  almost  a  specific.  The  in- 
dications are  dizziness,  flatulence  and  alternating  constipation  and 
diarrhea. 

For  gleet  a  solution  of  one  grain  to  four  ounces  of  water  (with 
the  addition  of  hydrochloric  acid)  will  prove  beneficial;  the  irritabil- 
ity of  the  urethra  is  lessened  and  the  disease  cut  short. 

One  full  dose,  one  granule,  gr.  i-ioo,  followed  at  fifteen-minute 
intervals  by  small  doses,  gr.  i-iooo,  will  stop  nausea  promptly,  ex- 
cept perhaps  in  cases  caused  by  cirrhosis  of  the  liver.  In  nearly 
every  case  copper  arsenite  is  best  taken  in  hot  solution,  and  in  in- 
fantile diseases  the  small  dose,  gr.  i-iooo  frequently  repeated,  will 
prove  of  most  benefit. 

In  all  internal  use  of  copper  arsenite,  as  improvement  is  manifest, 
the  doses  should  be  diminished  in  frequency,  decreased  in  strength, 
or  both.  Thus  given,  there  is  no  safer  remedy  in  use ;  and  its  marked 
effectiveness  in  the  tiny  doses  recommended,  has  been  the  means  of 
convincing  many  of  the  utility  of  the  small  and  frequently-repeated 
doses,  leading  them  to  an  investigation  of  the  merits  of  and  the  ulti- 
mate adoption  of  alkaloidal  or  active-principle  (small-dose)  method. 

MANGANESE. 

Standard  granules   (the  arsenate) — Gr.  1-67;  gm.  .001;  gr.  1-6;  gm.  .01. 

Manganese  presents  close  analogies  to  iron,  with  which  it  is  usu- 
ally found  associated  in  nature.  Vauquelin  discovered  it  in  the  hair ; 
Bley  and  others  in  biliary  and  renal  calculi;  Wurzer  in  the  blood; 
Petrequin  in  laudable  pus ;  Jahn  in  the  urine  of  a  diabetic  horse,  and 
Sprengel  and  Bibra  in  that  of  a  beef.  More  recently  it  has  been  found 
by  Turner  in  the  urine  of  a  man.  But  many  have  failed  to  demon- 
strate it  in  the  red  blood  globules,  nor  does  it  form  an  integral  con- 
stituent of  hemoglobin.  Its  existence  in  the  red  globules,  many  times 
affirmed,  is  considered  doubtful  by  Gautier  (Rabuteau). 

The  detection  of  a  minute  trace  of  manganese  in  the  blood  has 
led  some  to  proclaim  a  manganese-anemia,  as  well  as  an  iron-anemia. 
Hannon  distinguished  both,  but  Petrequin  asserted  that  both  iron  and 
manganese  were  deficient  in  all  chloroses.  He  therefore  considered 
both  essential  in  the  treatment  of  chlorosis,  but  said  that  the  ordinary 
martial  preparations  all  combined  manganese.  This,  however,  was 


APPENDIX  .  IS 

denied  by  Trousseau  and  Pidoux,  and  later  by  Rabuteau.  The  ex- 
periments of  the  latter,  confirmed  by  Hayem,  showed  that  instead  of 
being  hematogenous  like  iron,  manganese  actually  diminished  the 
red  blood  globules. 

Gubler  ranked  manganese  with  iron  as  a  constituent  of  the  blood, 
and  its  salts  as  tonic  reconstituents,  a  general  and  local  stimulant,  in 
all  respects  closely  resembling  iron. 

Potain  recommended  manganese  when  in  chlorosis  iron  was  not 
well  borne,  a  not  infrequent  condition ;  also  when  iron  proved  too 
stimulating,  as  with  persons  predisposed  to  tuberculosis.  Before  his 
time  Trousseau  had  forcibly  insisted  on  the  danger  of  iron  in  these 
cases,  where  it  was  apt  to  induce  hemorrhages  from  the  bronchi. 
Potain  affirmed  that  manganese  surely  provoked  the  formation  of  red 
cells.  He  described  a  case  of  leucocythemia,  so  marked  that  there 
was  one  white  cell  for  each  red  one,  the  patient  being  unable  to  take 
iron,  in  which,  after  a  month's  treatment  with  manganese,  the  normal 
proportion  was  re-established.  It  is  unfortunate  that  manganese  is 
nearly  always  administered  with  iron,  so  that  it  is  impossible  to  dis- 
tinguish the  value  of  the  former. 

Cahn's  studies  of  manganese  may  be  thus  summarized:  Intro- 
duced directly  into  the  blood  it  is  not  incorporated  in  the  red  cells.  It 
is  reabsorbed  and  transported  by  the  parenchymatous  organs,  and 
eliminated  mainly  by  the  intestinal  mucosa,  and  passes  out  with  the 
feces.  Reabsorption  by  healthy  intestinal  muscosa  does  not  occur. 

Overdoses  cause  toxic  symptoms,  especially  when  given  intrave- 
nously. Seven  decigrams  (10  grains)  of  the  sulphate  injected  into 
the  veins  of  a  small  dog  killed  it.  Four  grams  (one  dram)  by  the 
stomach,  killed  a  rabbit.  In  a  bitch  Rabuteau  saw  an  intravenous 
injection  of  the  lactate,  two  grains,  cause  trismus,  opisthotonos,  and 
death — all  on  the  following  day. 

If  the  organism  of  man  reacts  like  that  of  the  dog,  a  subcutaneous 
injection^of  five  decigrams  (gr.  7^2)  should  kill  an  adult  man  within 
24  hours. 

Massive  doses  given  by  the  mouth  cause  gastrointestinal  catarrh, 
all  the  drug  being  absorbed,  and  principally  eliminated  by  the  kidneys. 
In  animals,  toxic  doses  of  manganese  cause  vomiting,  diarrhea,  par- 
alysis, tetanic  spasms,  exophthalmos,  jaundice,  somnolence,  diminu- 
tion of  motility  and  sensation,  and  abolition  of  reflex  irritability 
quickly  followed  by  death  from  paralysis  of  the  heart.  The  vaso- 
motor  center  is  paralyzed  before  the  heart.  The  urine  contains  bil- 


16  APPENDIX 

iary  coloring-  matter,  hyaline  casts,  albumin  and  leucocytes.  In 
chronic  toxemia  from  manganese  the  jaundice  is  very  grave. 

Van  Renterghem  quotes  one  case  of  poisoning  by  manganese  in 
man.  The  workmen  who  grind  manganese  are  subject  to  paralysis 
of  the  muscles  of  the  extremities  and  of  phonation ;  sometimes  per- 
manent. Some  not  cured  for  years.  Autopsies  of  animals  killed  by 
manganese  show  gastroenteritis,  and  inflammation  of  the  spleen,  liver 
and  heart.  The  inflamed  bowel  is  stained  with  bile.  Chronic  poison- 
ing causes  disease  of  the  renal  tissues. 

The  black  oxide  of  manganese,  in  doses  of  30  to  60  grains,  is  em- 
ployed for  acidity  and  waterbrash.  Mix  20  grains  with  a  dram  of 
magnesia  in  a  glass  of  water  and  let  the  patient  take  a  small  swallow 
every  five  minutes  till  relieved;  this  is  often  very  effective.  Gubler 
also  gave  this  salt  of  manganese  for  chlorosis,  anemia,  scurvy  and 
cachexias,  the  daily  dose  being  7^2  grains. 

Manganese  carbonate  is  employed  in  the  same  affections -and  in 
the  same  doses  (Gubler).  Manganese  sulphate  is  a  caustic  solvent 
like  potash  and  soda,  and  does  not  produce  insoluble  combinations 
with  animal  matter  like  iron  (Mitscherlich).  In  the  stomach  it  acts 
like  the  caustic  alkalies  mentioned,  causing  fatal  erosions.  It  has  been 
employed  as  a  purgative  cholagog,  in  doses  of  4  to  7/^2  grains  a  day, 
for  torpid  liver,  jaundice  and  gout.  Locally  it  has  been  applied  as  an 
ointment — one  part  to  eight  of  lard — for  neuralgias,  buboes,  and  to 
dissipate  the  residues  from  rheumatic  and  other  arthrites.  Manga- 
nese arsenate  has  been  used  to  some  extent  by  the  French  dosime- 
trists.  It  may  have  some  advantages  over  iron  arsenate  in  the  way 
of  solubility. 

The  most  important  item  in  the  foregoing  is  the  use  of  manganese 
in  leucocythemia.  The  arsenate  might  be  tested  here,  in  doses  of  gr. 
1-67  to  gr.  1-6,  several  times  a  day. 

Whether  potassium  permanganate  is  to  be  treated  therapeutically 
as  a  maganese  or  as  an  agent  sui  generis,  is  uncertain.  Very  important 
results  have  followed  its  employment,  which  do  not  harmonize  with 
any  as  yet  reported  from  any  other  preparation  in  which  manganese 
enters.  The  permanganate  was  introduced  as  a  remedy  for  amenor- 
rhea  many  years  ago,  and  acquired  considerable  repute ;  though  Leff- 
mann  and  others  showed  that  the  salt  was  decomposed  the  moment  it 
entered  the  stomach.  It  is  much  more  irritant  than  any  ordinary 
preparation,  and  doses  of  gr.  %  every  hour  soon  induce  nausea. 

Some  years  ago  a  Chicago  physician  began  the  use  of  the  per- 
manganate as  a  remedy  for  tubercular  phthisis,  on  account  of  its  sup- 


APPENDIX  17 

posed  "oxidizing"  qualities.  He  reported  that  in  every  case  the  pa- 
tients improved  so  decidedly  that  he  looked  for  a  cure,  when  they 
were  suddenly  seized  with  bronchial  hemorrhages,  usually  fatal.  The 
disposition  to  hemorrhage  seemed  very  decided,  and  invariable  when 
this  salt  was  pushed  to  full  dosage. 

This  would  indicate  caution  in  the  use  of  manganese,  especially 
the  permanganate  of  potassium,  in  persons  predisposed  to  tubercu- 
4osis,  or  to  bronchial  or  other  forms  of  hemorrhage.  But  a  drug  with 
such  decided  qualities  should  prove  of  therapeutic  value  when  prop- 
erly directed.  As  a  remedy  for  amenorrhea  the  writer  has  frequently 
administered  it  with  satisfactory  results.  The  dose  of  gr.  l/\.  every 
two  to  three  hours,  began  two  days  before  the  flow  is  due  and  con- 
tinued for  a  week,  rarely  fails  to  induce  the  discharge  when  the  pa- 
tient has  the  blood  to  spare.  Whether  it  is  effective  or  safe  during 
pregnancy  the  writer  has  no  knowledge — he  has  never  given  any 
emmenagog  until  certain  that  pregnancy  was  not  present. 

STILLINGIN. 

Standard  granule — Gr.  1-6;  gm.,  .01. 

This  remedy,  representing  Stillingia  sylvatica,  has  won  for  itself 
the  name  of  the  "vegetable  mercurial"  and  those  who  have  watched 
its  effects  in  syphilis  consider  it  even  more  efficient  than  hydrar- 
gyrum. 

One  of  the  great  drawbacks  to  the  use  of  stillingia  hitherto  has 
been  the  unstable  character  of  its  preparations,  neither  aqueous  nor 
alcoholic  menstrua  serving  to  preserve  the  drug  principle  any  length 
of  time.  Stillingin,  however,  is  unchangeable  and  gives  the  prac- 
tician an  effective,  potent  and  evenly-acting  remedy,  while  at  the 
same  time  it  well  represents  the  fresh  plant. 

Stillingin  may  be  termed  (for  want  of  a  better  word)  an  altera- 
tive par  excellence.  Alone,  or  with  one  of  the  salts  of  mercury  or 
iodine,  it  gives  prompt  and  visible  results  in  scrofulous,  syphilitic 
and  tubercular  conditions.  Combined  with  phytolaccin  it  proves 
effective  in  goiter  and  tubercular  glands ;  with  rumicin  and  arsenic 
iodide  it  promptly  causes  the  disappearance  of  scrofulous  sores  and, 
with  proper  local  treatment,  leg  ulcers.  It  is  one  of  our  most  potent 
aids  to  the  successful  treatment  of  syphilis.  Whether  given  alone 
or  in  combination  Stillingin  must  be  exhibited  for  -prolonged  periods 
and  at  the  same  time  the  patient  requires  and  must  have  elimina- 
tives  and  hematinics.  The  dosage  varies:  gr.  1-6  to  1-3  should 
be  given  every  three  or  four  hours — always  to  effect.  It  is  an  excel- 


18  APPENDIX 

lent  drug  to  give  to  those  syphilitics  who  are  salivated.  As  far  as 
experience  serves,  this  remedy  is  most  effective  in  the  primary  and 
secondary  forms  of  syphilis,  but  is  not  out  of  place  in  the  third 
degree,  a  state  to  which,  early  recognized  and  properly  treated  with 
modern  antidotal  and  supportive  remedies,  few  cases  of  syphilis 
need  be  allowed  to  attain.  Combined  with  lobelin  it  may  be  given 
in  alternation  with  calcium  iodized  in  croup.  Stillingin  is  also  use- 
ful in  bronchial  affections  in  which  there  is  tightness  and  irritation*, 
but  little  or  no  expectoration. 

COMBINATION  PRESCRIBING. 

The  employment  of  the  active  principles  in  medicine  strongly  op- 
poses the  habit  of  depending  on  prescriptions.  Given  a  remedial 
agent  whose  effect  is  uniform  in  the  nature  and  the  degree  of  its 
action  and  the  physician  learns  to  study  his  case  till  he  sees  the  indi- 
cation for  this  remedy,  and  then  he  administers  it  until  he  perceives 
the  effect  he  desires.  If  he  has  correctly  estimated  the  need,  and 
knows  the  remedy,  the  result  is  not  doubtful,  but,  given  to  effect,  is 
absolutely  certain.  His  therapeutics  takes  from  this  a  character  of 
precision,  of  decisiveness,  to  which  no  approximation  could  be  had 
under  the  old  system.  Hence,  the  use  of  active  principles  leads  to 
the  selection  of  single  remedies  for  single  indications.  To  give  two 
or  more  medicines  for  a  single  indication  would  needlessly  compli- 
cate matters,  obscure  the  result  and  hark  back  to  the  old,  idle,  vicious 
system  of  giving  a  number  of  remedies  in  the  hope  that  some  one 
among  them  might  happen  to  meet  the  true  indication,  which  is  not 
really  recognized  by  the  prescriber  but  only  guessed  at — a  shot  in  the 
dark. 

Numerous  prescription  books  find  ready  sale.  The  most  popular 
work  on  therapeutics  is  that  which  contains  the  most  prescriptions. 
The  pocket  case  records  are  padded  with  prescriptions,  that  the  prac- 
tician may  turn  to  them  and  select  a  formula  that  he  guesses  may  fit 
his  case,  trusting  neither  his  own  knowledge  nor  his  memory.  Pos- 
sibly some  retentive  memory  may  hold  the  formulas  for  brown  mix- 
ture, compound  cathartic  pills  and  chlorodyne,  but  the  writer  does 
not  believe  one  physician  out  of  ten  thousand  who  daily  prescribes 
these  can  give  the  formulas  and  tell  what  indication  exists  for  each 
of  the  ingredients,  and  how  to  ascertain  whether  the  effect  of  each 
has  been  secured,  and  just  enough  of  the  desired  effect  and  no  more. 

If  the  practician  will  learn  the  effects  of  each  remedy  singly,  so 


THERAPEUTIC  NOTES 


THERAPEUTIC  NOTES 


APPENDIX  19 

that  he  can  thus  recognize  it  when  manifested,  he  will  be  an  accom- 
plished therapeutist,  far  above  the  ordinary  physician.  He  will  not 
allow  a  patient  in  a  hospital  under  trained  nurses  to  die  of  strychnine 
poisoning-  and  never  suspect  it  until  the  victim  is  buried.  He  will  at 
once  distinguish  between  the  phenomena  attributable  to  the  disease 
and  those  due  to  any  drug  that  may  have  been  taken ;  and  this  does 
not  seem  too  much  to  ask  of  the  man  who  holds  the  lives  of  the  sick 
in  his  hands. 

But  the  use  of  single  remedies  to  meet  single  indications  does  not 
imply  that  but  one  remedy  is  always  indicated  at  the  same  time. 
Disease  is  rarely  so  simple.  In  its  causation,  its  pathologic  nature, 
and  its  phenomena,  as  they  develop,  there  are  frequently  more  than 
one  indication  presenting.  We  may,  therefore,  administer  several 
medicines  at  the  same  time,  each  to  meet  its  own  specific  need.  We 
have,  then,  to  watch  for  the  desirable  effect  of  each,  ready  to  in- 
crease, diminish  or  suspend  it,  without  reference  to  the  other  agents 
given  simultaneously.  Hence  we  rebuild  the  prescription  we  had 
demolished,  but  on  a  totally  different  foundation.  Instead  of  a  form- 
ula for  "typhoid  fever,"  we  may  have  a  combination  of  one  remedy 
for  the  fever,  another  to  sustain  the  heart,  a  third  to  disinfect  the 
bowels,  a  fourth  to  subdue  the  tendency  to  nocturnal  delirium,  etc. ; 
and  each  of  these  remedies  is  given  in  doses  nicely  adjusted  to  meet 
the  needs  of  that  particular  person  at  that  particular  time,  and  is  dis- 
continued when  the  need  has  passed  away.  Thus  the  "prescription" 
may  be  varied  every  day ;  and  is  never  the  same  for  any  two  patients. 
It  is  a  garment  cut  to  fit  the  wearer,  but  elastic,  expanding  and  con- 
tracting as  the  abdomen  is  filled  or  emptied,  thickening  as  the  days 
grow  cool  and  becoming  thinner  when  summer  approaches.  The  old 
prescription  is  a  suit  of  armor;  if  it  does  not  fit  you,  and  the  enemy  is 
at  your  gate — well,  you  can  run  faster  without  it. 

Another  step  we  have  taken — a  long  one — and,  we  must  confess, 
a  step  backward.  In  some  cases  it  has  been  found  that  the  study  of 
the  conditions  presenting  in  disease  reveals  a  group  of  associated 
phenomena  occurring  together  so  frequently  that  a  certain  combina- 
tion of  remedies  is  indicated  with  corresponding  frequency.  This 
has  led  to  the  use  of  certain  compounds  for  many  cases.  There  are 
advantages  and  objections  to  this.  The  advantages  are  found  in  the 
case  of  dispensing  and  taking  a  single  granule,  instead  of  a  number. 
The  disadvantage  is  that  the  same  dose  and  frequency  of  dosage  is 
employed  for  different  persons  who  may  not  respond  similarly  to 


20  APPENDIX 

renew,  in  the  practician,  the  very  fault  we  have  been  trying-  to  erad- 
icate— the  dependence  on  set  and  inelastic  formulas. 

When  the  physician  gets  beyond  the  "a-b  abs"  of  his  work  and 
begins  to  see  beyond  disease  names,  into  disease  conditions,  the  phe- 
nomena of  the  vasomotors  must  impress  him  with  their  importance. 
In  all  febrile  maladies  and  in  a  majority  of  others  they  are  of  car- 
dinal importance.  We  know  but  little  about  them — we  do  not  as  yet 
know  certainly  whether  we  possess  one,  or  two,  or  any,  special  sets 
of  vasomotor  nerves — but  the  little  we  do  know  is  priceless.  To 
many  physicians  this  talk  of  vasomotors  is  mysterious — it  is  Greek, 
or  worse,  but  in  reality  it  is  simple  enough  to  be  explained  on  me- 
chanical principles. 

Take  as  an  example,  pneumonia :  The  beginning  of  the  pulmon- 
ary inflammation  sees  an  increase  of  the  blood  in  the  pulmonary 
capillaries — ergo,  their  caliber  is  increased,  and  this  means  that  the 
vasoconstrictors  are  weakened  or  paretic,  since  they  are  unable  to 
maintain  the  normal  caliber  of  the  vessels  by  normal  tonicity.  This 
vasoconstrictor  paresis  indicates  the  use  of  strychnine,  which  directly 
antagonizes  it  and  restores  the  normal  tone.  It  comes  under  the  cate- 
gory of  foods,  then,  since  it  imparts  to  the  cells  what  they  require  to 
restore  them  to  the  state  of  normality. 

But  this  state  of  vasomotor  paresis  is  not  universal  over  the  en- 
tire body,  but  only  in  the  "inflamed"  tissues.  There  is  no  reason  to 
believe  that  the  total  quantity  of  blood  in  the  body  has  been  in- 
creased; its  distribution  has  been  disturbed,  the  circulatory  equilib- 
rium has  been  destroyed.  As  there  is  too  much,  blood  in  the  pulmon- 
ary capillaries,  there  must  be  too  little  in  some  other  vessels.  The 
caliber  of  the  latter  is  therefore  lessened,  the  vasoconstrictors  are  too 
strong  for  their  antagonists,  or  are  in  a  spastic  state.  We  find  that 
aconitine  or  veratrine  will  relax  this  spasm  and  restore  the  circula- 
tory equilibrium  by  permitting  the  surplus  blood  to  flow  out  of  the 
dilated  pulmonary  capillaries  into  the  vessels  which  should  con- 
tain it. 

By  adopting  either  of  these  methods  we  combat  the  condition 
presenting  in  pneumonia,  and  accordingly  we  find  one  set  of  praeti- 
cians  stimulating  the  paretic  vasomotors  with  strychnine,  digitalis  or 
ergot,  while  another  set  relax  the  spastic  vessels  with  aconite,  vera- 
trum,  antimony  or  blood-letting,  and  each  rightfully  claims  that 
their  treatment  is  of  benefit  and  saves  far  more  patients  than  does 
the  expectant  do-nothing  method. 


APPENDIX  21 

To  the  genius  of  Burggraeve  we  owe  the  discovery  that  both 
principles  of  treatment  may  be  applied  at  one  and  the  same  time; 
that  we  may  dilate  with  aconitine  and  contract  with  digitalin  at 
once;  and  that  the  results  are  better  than  when  either  of  these 
methods  is  employed  alone.  At  first  sight  this  doctrine  seems  ab- 
surd— for  how  can  we  stimulate  and  sedate  at  the  same  time? 
But  this  is  perfectly  in  harmony  with  the  behavior  of  the  cells  of  the 
body  toward  foods.  All  the  supplies  ,ior  the  body  circulate  equally 
through  the  blood;  the  bone  cells  appropriate  lime,  the  nerve  cells 
fat  and  phosphorus,  the  muscle  cells  iron,  the  other  cells  take 
exactly  what  they  require  to  maintain  their  physiologic  balance,  and 
no  more.  We  do  not  find  either  taking  what  may  be  required  only 
by  others.  If  each  takes  what  it  requires  to  maintain  equilibrium, 
why  attempt  to  draw  a  distinction  between  foods  and  medicines? 
There  is  none  in  reality.  If  the  cell  will  be  restored  to  normal 
equilibrium  by  a  particle  of  aconitine,  the  cell  takes  up  the  aconi- 
tine; if  another  cell  requires  strychnine,  it  takes  it  up  because  that 
is  what  it  requires.  Hence  the  blood  may  carry  both  to  every 
cell,  and  each  will  take  up  that  for  which  its  needs  create  an  affin- 
ity; and  physiologic  equilibrium  results.  Hence  the  prescription  of 
aconitine  and  digitalin  together  is  based  upon  simple  and  easily 
comprehensible  reasoning. 

Digitalin  has  besides  the  important,  property  of  sustaining  the 
heart,  and  this  is  universally  admitted  to  be  a  cardinal  necessity 
in  the  treatment  of  fevers.  In  some  cases,  known  as  asthenic,  there 
is  a  greater  need  for  such  sustaining,  and  here  it  is  customary 
to  add  strychnine  arsenate,  completing  the  celebrated  Trinity  or 
Triad  of  Burggraeve.  In  other  cases,  known  as  sthenic,  there  is 
need  for  the  heart-action  to  be  moderated,  and  for  the  doors  of  elim- 
ination to  be  opened  widely,  and  for  these  purposes  Abbott  added 
veratrine  to  the  basal  aconitine  and  digitalin,  forming  the  justly 
celebrated  Defervescent  compound.  The  indications  for  one  or  the 
other  of  these  combinations  occur  so  frequently  that  they  are  use- 
fully employed  in  a  single  granule.  In  treating  fevers  it  is  easy 
to  change  from  one  of  them  to  the  other,  and  back  again,  as  the 
indications  vary  from  day  to  day.  The  "Dosimetric  Trinity"  of 
Burggraeve  and  the  "Defervescent  Compound,"  Abbott,  are,  there- 
fore, legitimate  and  desirable  compounds. 

Somewhat  different  in  its  nature  is  a  combination  frequently 
employed  for  the  relief  of  pain  of  a  spasmodic  character — and  very 
many  such  exist,  like  the  colics.  The  agent  indicated  is  the  most 
powerful  of  antispasmodics,  atropine.  To  this  we  add  glonoin,  be- 
cause it  dilates  the  blood  vessels  quickly  and  allows  the  atropine  to 


22  APPENDIX 

be  more  rapidly  absorbed  and  carried  to  the  seat  of  disease.  Glo- 
noin  relaxes  spasm  quickly,  but  its  effects  are  evanescent.  Atropine 
prolongs  and  sustains  the  effect.  To  these  strychnine  arsenate  is 
added,  for  this  reason :  Spasm  is  not  to  be  looked  upon  as  an  ex- 
cess qf  nervous  energy  but  rather  the  contrary.  When  the  con- 
trol of  the  nerves  over  any  structure  is  weakened  the  first  effect 
is  spasm,  which  always  precedes  paralysis.  The  use  of  strychnine 
in  appropriate  doses  therefore  increases  the  control  of  the  nerves 
over  their  subject  tissues,  and  in  moderate  doses  combats  the  tend- 
ency to  that  disordered  action  that  comes  from  imperfect  con- 
trol, which  we  denominate  spasm.  These  three  remedies,  therefore 
form  a  third  triad,  and  one  that  is  frequently  required. 

To  illustrate  the  difference  between  these  prescriptions  and  the 
older  ones,  take  one  purporting  to  come  from  one  of  the  most  dis- 
tinguished therapeutists  of  the  day — a  man  who  knows  better :  For 
asthma  he  recommends  belladonna,  hyoscyamus  and  stramonium. 
Each  of  these  contains  the  alkaloids  of  the  solanacea,  atropine  and 
hyoscine,  in  uncertain,  variable  quantities  and  proportions.  Give  any 
one  of  them,  and  you  may  get  the  effect  of  atropine  or  that  of  hyos- 
cine, in  any  degree  from  none  at  all  to  a  toxic  or  even  lethal  result. 
That  makes  two  uncertainties  to  each — or  six  from  the  three. 

Now,  if  the  physician  deems  it  best  to  obtain  the  effect  of  atro- 
pine and  hyoscine  together — they  are  antagonistic  over  a  portion 
of  their  fields — why  not  give  exactly  as  much  of  each  as  he  deems 
advisable,  instead  of  trusting  to  chance  for  his  results?  Of  course, 
the  chances  are  that  he  will  get  an  atropine  effect,  little  if  any  modi- 
fied by  the  hyoscine  which  is  generally  smothered  under  its  powerful 
sister.  But  why  then  not  give  the  atropine  at  once  in  definite  doses 
whose  effects  are  so  well  known  that  the  nurse  may  be  directed 
just  when  to  stop?  By  this  means  all  possibility  of  an  overdose  or 
an  underdose  is  avoided.  All  that  is  necessary  to  say  to  her  is : 
"Give  the  medicine  until  the  patient  is  relieved;  or  until  she  says 
her  mouth  is  getting  dry." 

With  the  combination  of  three  solanaceous  galenics  it  is  neces- 
sary to  add:  "But  the  medicine  may  not  do  either,  but  may  put 
her  to  sleep ;  it  may  stimulate  or  sedate  her ;  and  you  will  have  to 
watch  for  either  of  these  effects. 

Some  clinicians  may  have  nurses  who  can  be  trusted  with  such 
directions,  but  we  have  found  uncertainty  as  to  the  effects  to  be 
expected  from  medicines  about  the  most  disastrous  lesson  that  can 
be  taught  the  attendants  of  the  sick,  breeding  doubt  and  timidity  as 
to  the  drugs  and  corresponding  distrust  of  the  doctor  who  does 
not  know  what  his  medicines  are  really  going  to  do.  Directions 
to  nurses  cannot  possibly  be  too  simple  and  easily  comprehensible. 


THERAPEUTIC  NOTES 


THERAPEUTIC  NOTES 


THERAPEUTIC   NOTES 


THERAPEUTIC  NOTES 


Date  Due 


\ 


PRINTED  IN  u.s.*.  CAT.   NO.   24    161 


3  1970  00359  6860 


000417049  4 


WB960 
W35H2 
1901* 
Waugh,  William  F 

Text-book  of  alkaloidal 

therapeutics . . . 


WB960 
W35H2 
190U 
Waugh,  William  F 

Text-book  of  alkaloidal  therapeutics... 


